An MRI-first prostate cancer screening program could prevent 1 in 6 deaths, according to a new analysis published Thursday in JAMA Network Open.
Recent studies have touted the use of magnetic resonance imaging as a possible community-based testing tool for the disease. It’s currently the most common cancer among men, with more than 248,000 cases and 34,000-plus deaths anticipated this year in the U.S. alone, according to one estimate.
Building on recent MRI breakthroughs, scientists with University College London created a predictive model to forecast outcomes with different imaging screening programs. Those included an age-based pathway where all men ages 55-69 are imaged every four years, or a risk-based pathway utilizing a genetics blood test to refine who is screened.
They found success and believe the second strategy, in particular, warrants a prospective follow-up investigation to hash out the specifics.
“Our study shows that screening for prostate cancer—which could save between 16% and 20% of prostate cancer deaths—might be possible with targeted screening using genetic risk and MRI as part of the diagnostic pathway,” study co-author Mark Emberton, MD, a professor and dean of University College London’s faculty of medical sciences, said March 11. “This paves the way for further clinical trials to study the real-world implementation of such a screening program.”
To reach their conclusions, Emberton et al. created a hypothetical cohort of nearly 4.5 million individuals representing the number of men in England. They then simulated outcomes for such patients using age-based screening, with a standard prostate-specific antigen test every four years, followed by an MRI if they come up positive. The second pathway, meanwhile, would involve the same steps, but only for men who received a polygenic test—not yet widely available, the authors noted—to see if they met a certain genetic predisposition to the disease.
Researchers determined that screening those with a 3.5% risk of getting prostate cancer over the next 10 years—or about half of all men between ages 55-69 in England—produced the most benefit. In this case, providers would prevent about 16% of prostate cancer deaths while reducing overdiagnoses by about 27%. And using the age-based pathway would result in more deaths prevented at a rate of 20%, they noted. Emberton and co-authors recommended the risk-based strategy, however, because it limits misdiagnoses and unnecessary biopsies.
“Since there have been no randomized clinical trials of MRI-first screening strategies, this prostate cancer screening decision analytical model study incorporating MRI is very important,” Michael Borre, MD, PhD, with the Department of Urology, Aarhus University Hospital in Denmark, wrote in a corresponding JAMA Network Open editorial. “Moreover, the use of a countrywide screening program involving centers with varying degrees of MRI experience made the baseline for estimating outcomes associated with MRI screening very conservative and provided an increased built-in credibility,” the editorialist added later, while also touting the imaging strategy’s cost-effectiveness.
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.