Opportunistic Prostate Cancer Screening with Biparametric Magnetic Resonance Imaging (VISIONING).

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Prostate cancer (PCa) screening traditionally relies on prostate-specific antigen (PSA) and digital rectal examination (DRE).
• Biparametric magnetic resonance imaging (bpMRI) offers a non-invasive imaging alternative for PCa detection.
• Opportunistic screening aims to identify cancers in individuals not actively seeking screening.

Purpose of the Study:

• To evaluate bpMRI as a primary opportunistic screening tool for prostate cancer.
• To assess the effectiveness of bpMRI in identifying clinically significant prostate cancer (csPCa) without a PSA cut-off.
• To compare the detection rates of bpMRI against traditional screening methods.

Main Methods:

• A cohort of biopsy-naïve men over 45 years underwent 3 Tesla bpMRI, PSA testing, and DRE.
• Targeted-only biopsy was performed for lesions with Prostate Imaging Reporting and Data System (PI-RADS) scores of 3 or higher.
• Protocol adjustments included no immediate biopsy for PI-RADS 3 lesions, with follow-up MRI and biopsy only if lesions persisted or upgraded.

Main Results:

• 229 men were enrolled; 79 underwent biopsy, detecting PCa in 29 (12.7%) and csPCa in 21 (9.2%).
• bpMRI identified 21 csPCa cases, a detection rate that would have missed 38.1% of cases using PSA and DRE alone.
• The adjusted protocol reduced biopsies for PI-RADS 3 lesions by 54.6%, with 10.9 bpMRI scans needed per csPCa diagnosis (median PSA 1.26 ng/ml).

Conclusions:

• Opportunistic screening using bpMRI as a primary tool demonstrates higher sensitivity for csPCa detection compared to classical screening methods.
• bpMRI screening identified csPCa irrespective of PSA levels, suggesting its utility in a broader population.
• Further improvements in bpMRI effectiveness may be achieved by preselecting patients based on PSA levels, family history, and other biomarkers.