Repeated Prostate Cancer Screening Using Prostate-Specific Antigen Testing and Magnetic Resonance Imaging: A...

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Prostate cancer screening aims to improve outcomes, but optimal strategies for repeated screening are unclear.
• Magnetic resonance imaging (MRI) is explored to enhance the benefit-to-harm ratio of prostate cancer screening.
• Data on outcomes from repeated prostate-specific antigen (PSA)-based screening incorporating MRI are limited.

Purpose of the Study:

• To evaluate outcomes of repeat prostate cancer screening using PSA testing combined with MRI and prostate biopsies.
• To assess the detection rates of clinically significant and insignificant prostate cancer in a repeated screening setting.

Main Methods:

• Secondary analysis of the STHLM3-MRI randomized clinical trial involving men aged 50-74 years.
• Repeat screening included PSA testing, with biparametric MRI for PSA levels ≥3 ng/mL.
• Biopsies were performed for lesions with Prostate Imaging-Reporting and Data System (PI-RADS) scores of 3 or greater.

Main Results:

• Of 1500 men rescreened, 48 (3.2%) were diagnosed with clinically significant prostate cancer (Gleason score ≥3+4).
• Low-grade tumors (Gleason score 6) were detected in 11 men (0.7%).
• Elevated PSA levels (≥3 ng/mL) were common (44.5%), but MRI revealed suspicious lesions (PI-RADS ≥4) in only 4.9% of those scanned.

Conclusions:

• Biennial PSA and MRI-based prostate cancer screening demonstrated limited cancer detection in the second round.
• The detection rate of low-grade tumors was low, and many MRI scans did not identify significant lesions.
• Strategies to reduce resource utilization associated with MRI in repeated screening warrant further investigation.