MRI Quality and Reader Experience in Organized Prostate Cancer Screening: Insights from the PROBASE Trial

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Prostate magnetic resonance imaging (MRI) diagnostic performance relies on image quality and reader expertise.
• The PROBASE trial is a prospective screening study for prostate cancer (PCa) in men aged 45 years and older.
• This substudy focuses on the impact of MRI quality and expert reading on detecting clinically significant PCa (csPCa).

Purpose of the Study:

• To evaluate the effect of MRI quality and expert reference reading on the detection of clinically significant PCa (csPCa).
• To compare the diagnostic performance of local MRI readings versus expert reference readings.

Main Methods:

• Analysis of 516 participants from the PROBASE trial who underwent multiparametric MRI and biopsy.
• Comparison of local Prostate Imaging Reporting and Data System (PI-RADS) scores with reference readings by experienced uroradiologists.
• Assessment of MRI quality using Prostate Imaging Quality (PI-QUAL v1) and comparison between study sites.

Main Results:

• Expert reference reading showed higher NPV (92% vs. 86%), PPV (57% vs. 50%), and sensitivity (83% vs. 69%) compared to local reading.
• Local reading missed more csPCa in PI-RADS 1-2 lesions (17.1% vs. 2.9%) and had more false positives in PI-RADS 4-5 lesions (76 vs. 59).
• Lower MRI quality (PI-QUAL 1-3/5) was linked to reduced csPCa detection (46% vs. 62%) and a lower true negative rate (84% vs. 95%).

Conclusions:

• Expert reference MRI reading significantly enhances csPCa detection and minimizes unnecessary biopsies in screening settings.
• High-quality imaging, standardized protocols, and experienced readers are essential for future MRI-based prostate cancer screening.
• Variations in PI-QUAL scores between sites highlight the need for standardization in imaging protocols.