MRI could play central role in community-based screening for prostate cancer, experts say

Magnetic resonance imaging could play a central role in community-based screening for prostate cancer, eventually doing for the disease what mammography has accomplished in breast care.

That’s according to a new analysis and editorial, published Thursday in JAMA Oncology. Currently, experts do not recommend such population screening for the disease, with routine PSA testing doing little to improve survival rates, and even bringing about potential harm from overtreatment, experts noted.

Imaging offers an alternative, but there has been little research on its use in the general population, researchers with the Imperial College of London noted. Wanting to close this information gap, U.K. experts conducted an analysis to compare prostate-specific antigen testing up against MR imaging and ultrasound.

Their results showed that the latter should have a promising future in screening for the disease and addressing disparities in minority populations.

“These findings suggest that a short, noncontrast MRI may have favorable performance characteristics as a community-based screening test,” David Eldred-Evans, MBBS, with the Department of Surgery and Cancer at Imperial College London, and colleagues wrote Feb. 11.

To reach their conclusions, researchers recruited men treated at seven primary care practices and two imaging centers in the U.K. between 2018-2019. All told, they included 408 men between the ages of 50-69 for the investigation, with all undergoing a PSA test, an abbreviated MRI and ultrasound. Clinicians independently interpreted each test without knowledge of the other results, and both imaging exams were reported on a five-point scale of suspicion. Those positive for prostate cancer underwent a biopsy.

Bottom line: An MRI score of 4 or 5 was associated with improved detection of clinically significant prostate cancer. This occurred without an increase in the number of men who underwent a biopsy or were over diagnosed with clinically insignificant prostate cancer, if PSA testing alone was used. Ultrasonography, meanwhile, was not associated with improved screening performance, Eldred-Evans and colleagues reported.

In a corresponding editorial, two imaging experts applauded the results while sharing excitement for the future of MRI as a screening tool.

“In our continued endeavors to decrease the morbidity and mortality of prostate cancer, it is now apparent that MRI will play an important role,” Susan Lee, MD, PhD, and Aileen O’Shea, MBBCh BAO, both with the Department of Radiology at Massachusetts General Hospital, wrote in JAMA Oncology. “In the long run, if successful, prostate MRI will be able to join mammography and low-dose computed tomography of the thorax as an imaging screening test that saves lives and improves the general health of the population,” the two added later.