Role of Magnetic Resonance Imaging in Prostate Cancer Screening: A Pilot Study Within the Goteborg Randomised Screening Trial

Background: Magnetic resonance imaging (MRI) and targeted biopsies (TB) have shown potential to more accurately detect significant prostate cancer compared with prostatespecific antigen (PSA) and systematic biopsies (SB). Objective: To compare sequential screening (PSA + MRI) with conventional PSA screening. Design, setting, and participants: Of 384 attendees in the 10th screening round of theGoteborg randomised screening trial, 124 men, median age 69.5 yr, had a PSA of >= 1.8 ng/ml and underwent a prebiopsy MRI. Men with suspicious lesions on MRI and/or PSA > 3.0 ng/ml were referred for biopsy. SB was performed blinded to MRI results and TB was performed in menwith tumour-suspicious findings on MRI. Three screening strategies were compared (PSA >= 3.0 + SB; PSA >= 3.0 + MRI + TB and PSA >= 1.8 + MRI + TB). Outcome measurements and statistical analysis: Cancer detection rates, sensitivity, and specificity were calculated per screening strategy and compared using McNemar's test. Results and limitations: In total, 28 cases of prostate cancer were detected, of which 20 were diagnosed in biopsy-naive men. Both PSA >= 3.0 + MRI and PSA >= 1.8 + MRI significantly increased specificity compared with PSA >= 3.0 + SB (0.92 and 0.79 vs 0.52; p < 0.002 for both), while sensitivity was significantly higher for PSA >= 1.8 + MRI compared with PSA >= 3.0 + MRI (0.73 vs 0.46, p = 0.008). The detection rate of significant cancer was higher with PSA >= 1.8 + MRI compared with PSA >= 3.0 + SB (5.9% vs 4.0%), while the detection rate of insignificant cancer was lowered by PSA >= 3.0 + MRI (0.3% vs 1.2%). The primary limitation of this study is the small sample of men. Conclusion: A screening strategy with a lowered PSAcut-off followed by TB in MRI-positive men seems to increase the detection of significant cancers while improving specificity. If replicated, these results may contribute to a paradigm shift in future screening. Patient summary: Major concerns in prostate-specific antigen screening are overdiagnosis and underdiagnosis. We evaluated whether prostate magnetic resonance imaging could improve the balance of benefits to harm in prostate cancer screening screening, and we found a promising potential of using magnetic resonance imaging in addition to prostate-specific antigen. (C) 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.