Meta-analysis shows the need for MRI in prostate cancer screening
A collaboration of European scientists conducted a meta-analysis and found that there is a need to include magnetic resonance imaging (MRI) in prostate cancer screening. As reported in JAMA Oncology, MRI-based screening is associated with a reduction in the number of unnecessary prostate biopsies and sufficient efficacy in detecting clinically significant prostate cancer compared with strategies based on the use of prostate specific antigen levels alone.
Prostate cancer screening based on prostate-specific antigen (PSA) determination reduces prostate cancer mortality. However, it is also associated with unnecessary biopsies, overdiagnosis, overtreatment, and unclear impact on overall survival. Prostate MRI before biopsy is widely used in the diagnosis of prostate cancer because it helps to better detect clinically significant cancer and reduces the number of avoidable biopsies. However, there is no consensus on the role of MRI as a comprehensive prostate cancer screening tool.
Researchers from 13 countries, led by Shahrokh F. Shariat of the Medical University of Vienna, conducted a systematic review and meta-analysis of 12 studies on the effectiveness of MRI as a prostate cancer screening tool. The total sample included 80114 men. It turned out that compared to standard PSA-based screening, MRI was associated with a higher likelihood of detecting clinically significant prostate cancer (relative risk 4.15, p ≤ 0.001), lower likelihood of biopsy (relative risk 0.28, p ≤ 0.001).
According to the researchers, these results support and potentially strengthen the cumulative evidence that MRI may be a useful tool to mitigate the limitations of PSA-based screening, including overdiagnosis of indolent prostate cancer. However, the analysis also showed that the two screening strategies were similar in terms of prostate cancer detection rates, with the researchers calculating that the number of examinations required to detect one clinically significant prostate cancer with MRI was 59 and 63 for PSA-based detection.
PSA, however, continues to be an important prognostic oncomarker. For example, a study of half a million men showed that just one invitation to PSA screening is enough to slightly reduce prostate cancer mortality.