Refining prostate cancer screening

Screening for prostate cancer is burdened by a high rate of overdiagnosis. The most appropriate algorithm for population- based screening is unknown.

This study invited 37,887 men who were 50-60 years of age to undergo regular PSA screening. Participants with a PSA level of 3 ng/mL or higher underwent MRI imaging of the prostate; one-third of the participants were randomly assigned to a reference group that underwent systematic biopsy as well as targeted biopsy of suspicious lesions shown on MRI. The remaining participants were assigned to the experimental group and underwent MRI-targeted biopsy only. The primary outcome was clinically insignificant prostate cancer. Safety was also assessed.

The avoidance of systematic biopsy in favor of MRI-directed targeted biopsy for screening and early detection in persons with elevated PSA levels reduced the risk of overdiagnosis by half at the cost of delaying the detection of intermediate-risk tumors in a small proportion of patients.

N ENGL J Med; 387:2126-2137. DOI:10.1056/NEJMoa2209454