Prostate Cancer Screening - Lesson from the MRI studies

Article: Key Learning on the Promise and Limitations of MRI in Prostate Cancer Screening. Padhani et al. European Radiology https://doi.org/10.1007/s00330-024-10...

Key learning:
 The use of MRI enables the harm reduction benefits seen in individual early cancer
detection to be extended to both PSA risk-stratified and non-stratified prostate cancer
screening populations.
 MRI limitations include too many biopsies, low positive predictive value and imperfect reader variability in younger men, which requires standardising interpretations, biopsy methods, and integration into a quality diagnostic pathway.
 Premature to conclude that screening using MRI is proven to be effective. No improved detection of GG2+ cancers is seen; therefore, it is difficult to predict the long-term mortality impacts of the MRI approach.

Abstract:
MRI retains its ability to reduce the harm of prostate biopsies by decreasing biopsy
rates and the detection of indolent cancers in population-based screening studies
aiming to find clinically significant prostate cancers. Limitations of low positive
predictive values and high reader variability in diagnostic performance require
optimisations in patient selection, imaging protocols, interpretation standards,
diagnostic thresholds, and biopsy methods. Improvements in diagnostic accuracy
could come about through emerging technologies like risk calculators and polygenic
risk scores to select men for MRI. Furthermore, artificial intelligence and workflow
optimisations focused on streamlining the diagnostic pathway, quality control and
assurance measures will improve MRI variability.