Piotr Wysocki: Incorporation of MRI into prostate cancer screening decreases the risk of overdiagnosis and minimizes the burden of unnecessary systemic biopsies

Piotr Wysocki, Professor of Medicine and Head of the Department of Oncology at Jagiellonian University Hospital, shared on LinkedIn:

“A systemic review and meta-analysis compared the sophisticated prostate cancer (PC) screening approach incorporating magnetic resonance imaging (MRI) and targeted biopsy with PSA–based screening followed by systematic biopsy. The analysis included data from 80 114 men from 12 randomized clinical trials and prospective cohort studies.

Compared with standard PSA-based screening, the MRI-based screening (biopsy performed only in patients with PI-RADS score >=3) was associated with:
– Significantly higher odds of detecting a clinically significant PC when test results were positive (OR, 4.15; 95% CI, 2.93-5.88)
– Significantly decreased odds of biopsies (OR, 0.28; 95% CI, 0.22-0.36)
– Significantly decreased odds of insignificant cancers detected (OR, 0.34; 95% CI, 0.23-0.49)
– Nonsignificant differences in the detection of clinically significant PC (OR, 1.02; 95% CI, 0.75-1.37).
When the biopsy was performed only in patients diagnosed with PI-RADS >=4), there was a further reduction in the
– odds of detecting insignificant PCa (OR, 0.23; 95% CI, 0.05-0.97)
– odds of biopsies performed (OR, 0.19; 95% CI, 0.09-0.38; P = .01)
– without differences in the detection of clinically significant PC (OR, 0.85; 95% CI, 0.49-1.45).

The study provides definitive confirmation that prostate cancer screening cannot be based solely on PSA. In order to diminish the risk of overdiagnosis and decrease the number of unnecessary biopsies, it must be combined with MRI.”

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Source: Piotr Wysocki/LinkedIn