Screening with MRI, targeted biopsies could potentially cut prostate cancer overdiagnoses in half
Screening for prostate cancer with MRI and a targeted biopsy strategy could potentially cut prostate cancer overdiagnoses in half, according to a new analysis published Friday.
Most countries do not have nationwide prostate screening programs, with current PSA (prostate-specific antigen) test-based efforts prone to unnecessary biopsies and other concerns. Magnetic resonance imaging has shown promise as a first-line tool to fight a disease expected to kill 34,000 this year in the U.S. alone. And now new results in the New England Journal of Medicine are adding further evidence of its utility.
"Our results from a large, randomized study show that modern methods for prostate cancer screening maintain the benefits of screening, while decreasing the harms substantially. This addresses the greatest barrier to the introduction of nationwide screening,” author Tobias Nordström, an associate professor of urology with the Karolinska Institute in Sweden, said in a statement.
To reach their conclusions, scientists conducted a population-based trial of prostate cancer screening among men ages 50-74. Participants with PSA levels above a certain threshold were randomly assigned to either undergo a biopsy or an MRI with targeted biopsy, if imaging suggested prostate cancer. All told, nearly 13,000 men enrolled, while 1,532 met the study criteria based on their PSA and Stockholm3 test—a risk-prediction model using various factors to forecast the probability of developing the disease.
Clinically significant cancer was diagnosed in 21% of the MRI group compared to 18% in the standard biopsy population. And the percentage of clinically insignificant cancers was lower in the MRI group at just 4% compared to 12% among standard screening. When normalizing their results to a population of 10,000 men with elevated PSA levels referred for biopsy, the MRI approach would result in 409 fewer individuals undergoing biopsy. It would also spell 366 fewer biopsies with benign findings and 88 fewer clinically insignificant cancers detected than with the standard biopsy approach. These numbers, Nordström et al. noted, represent 48%, 73% and 62% lower incidences, respectively, with the use of the experimental approach.
“The markedly reduced incidences of unnecessary biopsy and diagnosis of clinically insignificant cancer address key barriers impeding implementation of population-based screening for prostate cancer,” investigators wrote July 9 in NEJM. “The reduced biopsy rate and potential downstream savings that result from less overtreatment offer potential cost savings that may offset the additional costs of MRI,” they added later.
You can read more about their findings—presented Friday at the European Association of Urology Congress—here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.