Primary MRI versus PSA-gated scans in Prostate Cancer Screening - how ready is it for mainstream implementation?

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Prostate cancer diagnosis often relies on PSA tests and subsequent MRI scans.
• Current PSA-gated MRI protocols may miss clinically significant prostate cancer (csPCa).
• Comparing 'primary' MRI (prostate MRI only) versus 'PSA-gated' MRI is crucial for optimizing screening.

Purpose of the Study:

• To compare cancer detection rates (CDR) between primary MRI and PSA-gated MRI for prostate cancer screening.
• To evaluate the detection of clinically significant prostate cancer (csPCa) and clinically insignificant prostate cancer (ciPCa) using both screening methods.

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, Embase, etc.) from 2000 to 2024.
• Studies included adult males without prior risk stratification, extracting data on CDR for csPCa (ISUP Grade Group ≥ 2) and ciPCa (ISUP Grade Group 1).
• Biopsy rates were also extracted for comparison.

Main Results:

• Primary MRI screening yielded significantly higher CDR for all prostate cancer (8.49% vs. 1.88%) and csPCa (5.93% vs. 1.15%) compared to PSA-gated MRI.
• No significant difference in ciPCa detection was observed between the two methods.
• Direct comparisons showed primary MRI had higher odds of detecting all cancer types, including csPCa and ciPCa.

Conclusions:

• Primary MRI screening demonstrates superior detection of csPCa compared to PSA-gated MRI.
• Primary MRI also leads to higher detection of ciPCa and increased needle biopsy rates.
• Further cost-effectiveness analyses are needed for widespread adoption of primary MRI screening.