Magnetic resonance imaging (MRI) has been suggested as a tool for guiding biopsy recommendations in prostate cancer (PC) screening.
To determine the performance of multiparametric MRI (mpMRI) in young men at age 45 yr who participated in a PC screening trial (PROBASE) on the basis of baseline prostate-specific antigen (PSA).
Participants with confirmed PSA ≥3 ng/ml were offered mpMRI followed by MRI/transrectal ultrasound fusion biopsy (FBx) with targeted and systematic cores. mpMRI scans from the first screening round for men randomised to an immediate PSA test in PROBASE were evaluated by local readers and then by two reference radiologists (experience >10 000 prostate MRI examinations) blinded to the histopathology. The PROBASE trial is registered as ISRCTN37591328 OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The local and reference Prostate Imaging-Data and Reporting System (PI-RADS) scores were compared, and the sensitivity, negative predictive value (NPV), and accuracy were calculated for both readings for different cutoffs (PI-RADS 3 vs 4).
Of 186 participants, 114 underwent mpMRI and FBx. PC was detected in 47 (41%), of whom 33 (29%) had clinically significant PC (csPC; International Society of Urological Pathology grade group ≥2). Interobserver reliability between local and reference PI-RADS scores was moderate (k = 0.41). At a cutoff of PI-RADS 4, reference reading showed better performance for csPC detection (sensitivity 79%, NPV 91%, accuracy of 85%) than local reading (sensitivity 55%, NPV 80%, accuracy 68%). Reference reading did not miss any PC cases for a cutoff of PI-RADS <3. If PI-RADS ≥4 were to be used as a biopsy cutoff, mpMRI would reduce negative biopsies by 68% and avoid detection of nonsignificant PC in 71% of cases.
Prostate MRI in a young screening population is difficult to read. The MRI accuracy of for csPC detection is highly dependent on reader experience, and double reading might be advisable. More data are needed before MRI is included in PC screening for men at age 45 yr.
Measurement of prostate specific antigen (PSA) is an effective screening test for early detection of prostate cancer (PC) and can reduce PC-specific deaths, but it can also lead to unnecessary biopsies and treatment. Magnetic resonance imaging (MRI) after a positive PSA test has been proposed as a way to reduce the number of biopsies, with biopsy only recommended for men with suspicious MRI findings. Our results indicate that MRI accuracy is moderate for men aged 45 years but can be increased by a second reading of the images by expert radiologists. For broad application of MRI in routine screening, double reading may be advisable.
European urology. 2023 Oct 18 [Epub ahead of print]
Matthias Boschheidgen, Peter Albers, Heinz-Peter Schlemmer, Susanne Hellms, David Bonekamp, Andreas Sauter, Boris Hadaschik, Agne Krilaviciute, Jan Philipp Radtke, Petra Seibold, Jale Lakes, Christian Arsov, Jürgen E Gschwend, Kathleen Herkommer, Marcus Makowski, Markus A Kuczyk, Frank Wacker, Nina Harke, Jürgen Debus, Stefan A Körber, Axel Benner, Glen Kristiansen, Frederik L Giesel, Gerald Antoch, Rudolf Kaaks, Nikolaus Becker, Lars Schimmöller
Dusseldorf University, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany., University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany; Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany., Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany., Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany., Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Department of Urology, University of Duisburg-Essen and German Cancer Consortium (dktk), University Hospital Essen, Essen, Germany., Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany., University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany., University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany; Department of Urology and Paediatric Urology, Elisabeth-Krankenhaus Rheydt, Städtische Kliniken Mönchengladbach GmbH, Mönchengladbach, Germany., Department of Urology, School of Medicine and Health, Technical University of Munich, Munich, Germany., Department of Urology, Medical University Hannover, Hannover, Germany., Department of Radiation Oncology, Heidelberg University Hospital, Ruprecht Karls University, Heidelberg, Germany., Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany., Institute of Pathology, University Hospital Bonn, Bonn, Germany., University Dusseldorf, Medical Faculty, Department of Nuclear Medicine, D-40225 Dusseldorf, Germany., Dusseldorf University, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany; Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, Düsseldorf (CIO ABCD), Germany., Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany., Dusseldorf University, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany; Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany. Electronic address: .