A recent BMJ Oncology study screens the prevalence of prostate magnetic resonance imaging (MRI) lesions in men based on age slightly than prostate-specific antigen (PSA) levels.

Study: Prevalence of MRI lesions in men responding to a GP-led invitation for a prostate health check: a prospective cohort study. Image Credit: Peackstock / Shutterstock.com

Background

In men, the prevalence of prostate cancer is comparatively common, with one recent study reporting that prostate cancer is the second commonest reason for cancer-related death amongst men in the UK. In truth, as in comparison with the US, France, Italy, and Spain, the U.K. has high age-standardized prostate cancer-specific mortality. 

The European Randomized Screening study for Prostate Cancer proposed that systematic screening can significantly reduce the prevalence of prostate cancer mortality. Nevertheless, the introduction of screening programs based on PSA and standard transrectal biopsy has been related to overdiagnoses, which ultimately results in unnecessary continued monitoring or overtreatment, each of which increase healthcare costs.

Although PSA and subsequent transrectal biopsy within the case of positive PSA is a widely accepted screening procedure, it will not be an accurate method to evaluate prostate cancer. Consistent with this commentary, the Cluster Randomized Trial evaluated greater than 400,000 men within the U.K. and estimated similar all-cause mortality rates between screened men (PSA) and controls. 

One previous study reported that MRI can reduce unnecessary biopsies in men with increased PSA. Considering this commentary, scientists previously explored whether age-defined MRI scans alone, no matter PSA, may be used to find out the prevalence of prostate cancer. 

The PROMIS study revealed that individuals with MRI lesions scoring 4 out of 5 were at a 50% increased risk of prostate cancer, whereas those with five out of 5 scores were at a 70% increased risk of prostate cancer. These findings indicate a positive association between histological rating and prostate cancer incidence.

In regards to the study

The ReIMAGINE prostate cancer screening study is a single-center cohort study designed to find out the potential for developing a screening approach using PSA and MRI.

Participants of the present study were chosen based on the response of general physician (GP) invitation. Here, men between the ages of fifty and 75 with no history of prostate cancer were chosen and subsequently subjected to a PSA blood test and screening MRI (sMRI).

Two radiologists independently scored the MRI findings as positive or negative. Men with a positive sMRI or PSA density of no less than 0.12 ng/mL were considered screen-positive. Screen-negative participants were excluded from the study. Screen-positive individuals were referred to the National Health Service (NHS) for further assessment for cancer.

Study findings

Of two,096 men across eight GP practices invited for this study, 457 men responded. Notably, older men responded to the invitation to a greater extent than relatively younger men. A multivariable logistic regression revealed that, as in comparison with Black men, white men were more likely to answer the invitation. 

Attributable to the limited availability of MRI, all eligible participants weren’t capable of take part in the study, which led to a complete of 303 men who were ultimately subjected to each screening tests. About 21% screened positive and were really helpful to NHS for further assessment.

Furthermore, one in six men had a screen-positive MRI, whereas one in twenty men tested positive for PSA density alone. Most men with a screen-positive MRI had PSA levels lower than 3.0 ng/mL.

Moreover, fifteen out of twenty-five men with a positive MRI with clinically significant cancer had PSA levels lower than 3.0 ng/mL. NHS assessments revealed that 9.6% of the screened men had clinically significant prostate cancer, while only one% had clinically insignificant disease.

Limitations

The present study has some limitations, including its small sample size. Moreover, since the scanning center was situated in London, the study was limited for wider invitation spread. A greater-advertised campaign would have increased the variety of participants.

The present study began before the onset of the coronavirus disease 2019 (COVID-19) pandemic, which subsequently paused participant recruitment between April 2020 and August 2020, after which the method restarted. Nevertheless, many individuals avoided visiting healthcare facilities attributable to the pandemic.

Conclusions

The present study revealed that two out of three men with a positive screening MRI had PSA levels lower than 3.0 ng/mL. These findings indicate that MRI may be used to screen for prostate cancer risk independent of the PSA test.

This MRI-based screening strategy might be used for primary assessment of prostate cancer. Because the PSA test is related to certain limitations in accurately detecting men in danger for prostate cancer, this MRI method might be an efficient alternative approach. 

In the longer term, the researchers emphasize the potential benefits of a community-based MRI delivery program using a mobile MRI scanner.

Source:

Journal reference:

• Moore, C. M., Frangou, E., McCartan, N., et al. (2023) Prevalence of MRI lesions in men responding to a GP-led invitation for a prostate health check: a prospective cohort study. BMJ Oncology. doi:10.1136/bmjonc-2023-000057