Ongoing and completed clinical trials on prostate cancer screening using MRI

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Traditional prostate cancer screening relied on prostate-specific antigen (PSA) testing and systematic biopsy, leading to overdiagnosis.
• Prostate MRI (Magnetic Resonance Imaging) has emerged as a more precise tool for detecting clinically significant prostate cancer.
• MRI shows high sensitivity for significant cancers and low sensitivity for low-grade cancers, making it suitable for pre-biopsy triage.

Purpose of the Study:

• To summarize evidence from clinical trials on MRI-based prostate cancer screening.
• To evaluate the effectiveness of MRI in improving the benefit-to-harm ratio of screening strategies.
• To assess the impact of MRI on cancer detection rates, biopsy rates, and overdiagnosis.

Main Methods:

• Review of diagnostic and randomized clinical trials incorporating MRI in prostate cancer screening pathways.
• Analysis of sequential screening strategies, including PSA-triggered MRI and ancillary kallikrein tests.
• Evaluation of ongoing trials assessing MRI protocols, image interpretation, and risk stratification.

Main Results:

• MRI-based screening pathways significantly reduce low-grade cancer detection and biopsy rates.
• These strategies maintain the detection of clinically significant prostate cancer.
• Sequential approaches like STHLM3-MRI trial reduce MRI scans and unnecessary biopsies.

Conclusions:

• MRI-based prostate cancer screening improves the benefit-harm balance compared to traditional methods.
• These strategies enable safer, more precise population-level screening by avoiding overdiagnosis and unnecessary procedures.
• Ongoing research focuses on optimizing MRI protocols, interpretation consistency, and scalability for widespread adoption.