Study finds first-line biparametric MRI less cost-effective than PSA for prostate cancer screening

From an economic perspective, first-line prostate-specific antigen (PSA) testing is favored over biparametric magnetic resonance imaging (bpMRI) for prostate cancer screening, mainly due to false-positive results and overdiagnosis, according to a study published online June 4 in the Annals of Internal Medicine.

Roman Gulati, from the Fred Hutchinson Cancer Center in Seattle, and colleagues examined the comparative effectiveness and cost-effectiveness of first-line bpMRI versus PSA-based screening in a decision analysis using a microsimulation model. The target population comprised U.S. men aged 55 years without prior screening or prostate cancer diagnosis.

The researchers found that first-line bpMRI versus PSA testing prevented two to three prostate cancer deaths and added 10 to 30 life-years per 1,000 men, but, depending on the biopsy imaging scheme, increased the number of biopsies by 1,506 to 4,174 and the number of over-diagnoses by 38 to 124.

The greatest net monetary benefits were seen for first-line PSA testing with multiparametric MRI followed by either biopsy approach for Prostate Imaging Reporting and Data System 4 to 5 at conventional cost-effectiveness thresholds. In sensitivity analysis, even if bpMRI was free, all men with low-risk prostate cancer underwent surveillance, and screening was quadrennial, first-line PSA still remained cost-effective.

"Our analyses suggest that the economic value of a first-line screening test, such as bpMRI, is driven by false-positive results and overdiagnoses rather than the cost of the test," the authors write. "Accordingly, our results suggest that screening efforts should focus on strategies that reduce false-positive results and over-diagnoses to improve cost-effectiveness."

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