Mary Wilson
Well-known member
Published Online First: 21 Aug 2023.
doi: 10.1136/bmjonc-2023-000168
Caroline M Moore1,2, Elena Frangou3, Neil McCartan1,4, Aida Santaolalla5, Douglas Kopcke6,7, Giorgio Brembilla6, Joanna Hadley2,6, Francesco Giganti1,7, Teresa Marsden1,2, Mieke Van Hemelrijck5, Fiona Gong6, Alex Freeman8, Aiman Haider8, Steve Tuck9, Nora Pashayan10, Thomas Callender11, Saran Green5, Louise C Brown3, Shonit Punwani6,7 and Mark Emberton2,12
Abstract
Objective
In men with a raised prostate-specific antigen (PSA), MRI increases the detection of clinically significant cancer and reduces overdiagnosis, with fewer biopsies. MRI as a screening tool has not been assessed independently of PSA in a formal screening study. We report a systematic community-based assessment of the prevalence of prostate MRI lesions in an age-selected population.
Methods and analysis
Men aged 50–75 were identified from participating general practice (GP) practices and randomly selected for invitation to a screening MRI and PSA. Men with a positive MRI or a raised PSA density (≥0.12 ng/mL[SUP]2[/SUP]) were recommended for standard National Health Service (NHS) prostate cancer assessment.
Results
Eight GP practices sent invitations to 2096 men. 457 men (22%) responded and 303 completed both screening tests. Older white men were most likely to respond to the invitation, with black men having 20% of the acceptance rate of white men.
One in six men (48/303 men, 16%) had a positive screening MRI, and an additional 1 in 20 men (16/303, 5%) had a raised PSA density alone. After NHS assessment, 29 men (9.6%) were diagnosed with clinically significant cancer and 3 men (1%) with clinically insignificant cancer.
Two in three men with a positive MRI, and more than half of men with clinically significant disease had a PSA <3 ng/mL.
Conclusions
Prostate MRI may have value in screening independently of PSA. These data will allow modelling of the use of MRI as a primary screening tool to inform larger prostate cancer screening studies.
https://bmjoncology.bmj.com/content/2/1/e000057
doi: 10.1136/bmjonc-2023-000168
Caroline M Moore1,2, Elena Frangou3, Neil McCartan1,4, Aida Santaolalla5, Douglas Kopcke6,7, Giorgio Brembilla6, Joanna Hadley2,6, Francesco Giganti1,7, Teresa Marsden1,2, Mieke Van Hemelrijck5, Fiona Gong6, Alex Freeman8, Aiman Haider8, Steve Tuck9, Nora Pashayan10, Thomas Callender11, Saran Green5, Louise C Brown3, Shonit Punwani6,7 and Mark Emberton2,12
Abstract
Objective
In men with a raised prostate-specific antigen (PSA), MRI increases the detection of clinically significant cancer and reduces overdiagnosis, with fewer biopsies. MRI as a screening tool has not been assessed independently of PSA in a formal screening study. We report a systematic community-based assessment of the prevalence of prostate MRI lesions in an age-selected population.
Methods and analysis
Men aged 50–75 were identified from participating general practice (GP) practices and randomly selected for invitation to a screening MRI and PSA. Men with a positive MRI or a raised PSA density (≥0.12 ng/mL[SUP]2[/SUP]) were recommended for standard National Health Service (NHS) prostate cancer assessment.
Results
Eight GP practices sent invitations to 2096 men. 457 men (22%) responded and 303 completed both screening tests. Older white men were most likely to respond to the invitation, with black men having 20% of the acceptance rate of white men.
One in six men (48/303 men, 16%) had a positive screening MRI, and an additional 1 in 20 men (16/303, 5%) had a raised PSA density alone. After NHS assessment, 29 men (9.6%) were diagnosed with clinically significant cancer and 3 men (1%) with clinically insignificant cancer.
Two in three men with a positive MRI, and more than half of men with clinically significant disease had a PSA <3 ng/mL.
Conclusions
Prostate MRI may have value in screening independently of PSA. These data will allow modelling of the use of MRI as a primary screening tool to inform larger prostate cancer screening studies.
https://bmjoncology.bmj.com/content/2/1/e000057