Detection of prostate cancer: PSA screening combined with MRI-targeted biopsy

This study looked at the effectiveness and safety of using MRI screening to detect prostate

cancer in men aged 50-60. Researchers divided participants into two groups: one had systematic biopsies (where the prostate gland is charted into six regions and two biopsy samples are taken from each region for a total of 12 samples, whether or not there is a suspicious area seen in the region), and the other had MRI-targeted biopsies (where only those regions with suspicious MRI findings were biopsied). The main goal was to see if MRI screening could reduce diagnoses

of low-risk, clinically insignificant prostate cancers, with secondary goals of identifying more serious cases.

Over about 4 years, fewer cases of prostate cancer were found in the MRI- targeted group (2.8%) compared to the systematic biopsy group (4.5%). Importantly, the MRI-targeted approach significantly reduced the number of low-risk cancer diagnoses by more than half. Detection of serious, high- risk cancers was similar between groups, with few severe side effects.

The study concluded that using MRI to guide biopsy decisions helped avoid unnecessary diagnoses of low-

risk prostate cancer without increasing the risk of missing more dangerous cases. Thus, the authors assume that failure to detect “MRI-invisible” prostate cancers by not sampling MRI- normal appearing areas is an acceptable strategy; however, long-term results are not yet available to prove this assumption. Nevertheless, there is increasing short-term data to suggest that MRI-visible prostate cancers are more likely to be serious than MRI- invisible cancers.

N. Engl. J. Med; 2024 Sep 26; 391 (12)1083- 1095.