Results from the Göteborg-2 Prostate Cancer Screening Trial

Vincent Gnanapragasam, Chair in Urology at the University of Cambridge and an Honorary Consultant Urologist at Addenbrooke’s Hospital, shared a post on X about a recent paper titled “Prostate Cancers in the Prostate-specific Antigen Interval of 1.8–3 ng/ml: Results from the Göteborg-2 Prostate Cancer Screening Trial” published in European Urology.

Authors: Fredrik Möller, Marianne Månsson, Jonas Wallström, Mikael Hellström, Jonas Hugosson, Rebecka Arnsrud Godtman.

“So PSA and MRI in low PSA (or MRI screening) lets break it down…a little. . Prostate Cancers in the Prostate-specific Antigen Interval of 1.8–3 ng/ml: Results from the Göteborg-2 Prostate Cancer Screening Trial – European Urology.

670 men with PSA 1.8-3.0.
MRI in all.
PIRADS 3-5 in 160 (24%).
PIRADS 4-5 in 108 (16.1%).
Presume all organ confined Biopsies performed in 156 (23%).

Benign/no cancer in 606 (90.4% of n=670).
Any cancer in 9.5%.
Grade Group 1 in 33 (4.9%).
Grade Group 2 or more in 31 (4.6%).
Grade Group 3 or more in 7 (1.0%).

Therefore (assuming we don’t want to detect GG 1).
639 unnecesary MRI (95% of MRI done in this cohort).
125 unnecessary biopsies (80% of biopsies done).

To detect a 1% incidence of cancers that definitely need treating.

4.6% if we are determined to radically treat all GG2.

Would they have eventually been detected by PSA>3. Yes.

– IMO its clear : MRI should not be used as a screening tool.
– Congrats to authors.

Oh and we can look at 15 yr survival estm survival gain from treatment : using Predict Prostate.

Based on median PSA 0.7, Age 58,stage T2, and no co-morbidity (no bx info).

The 33 GG1- 3% gain vs 9% risk of OCM.

The 24 GG2 -4% gain vs 9% OCM.

The 4 GG3 – 6% gain vs 9% OCM.”

Source: Vincent Gnanapragasam/X