Evaluation of a Solely MRI-based Prostate Cancer Screening Programme - Visioning Stage II

You have accessJournal of UrologyCME1 Apr 2023MP55-01 EVALUATION OF A SOLELY MRI-BASED PROSTATE CANCER SCREENING PROGRAMME - VISIONING STAGE II Marc Matthias, Christian Wetterauer, Heike Püschel, Helge Seifert, Alexander Deckart, David Jean Winkel, Lukas Bubendorf, Daniel Boll, Elmar Merkle, and Cyrill Rentsch Marc MatthiasMarc Matthias More articles by this author , Christian WetterauerChristian Wetterauer More articles by this author , Heike PüschelHeike Püschel More articles by this author , Helge SeifertHelge Seifert More articles by this author , Alexander DeckartAlexander Deckart More articles by this author , David Jean WinkelDavid Jean Winkel More articles by this author , Lukas BubendorfLukas Bubendorf More articles by this author , Daniel BollDaniel Boll More articles by this author , Elmar MerkleElmar Merkle More articles by this author , and Cyrill RentschCyrill Rentsch More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003308.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The current literature indicates a superior prognostic performance of prostate MRI as compared to prostate-specific antigen (PSA) for prostate cancer (PCa) detection. This study evaluates the implementation of biparametric MRI (bpMRI) of the prostate as a PSA-independent screening tool for PCa. Following an interims analysis our study protocol was adjusted in order to reduce the detection of nonclinically relevant prostate cancer (< WHO/ISUP II). METHODS: We included asymptomatic, biopsy-naïve patients older than 50 years into our study. All patients underwent 3 Tesla bpMRI of the prostate. In the presence of a suspicious lesion PI-RADS >3, only targeted biopsy was performed. After an interims analysis (n=110) the study protocol was adjusted and PI-RADS 3 lesions were re-assessed through a 6 month follow-up MRI and only led to a biopsy if the lesion was persistent, growing or PI-RADS > 3. Template prostate biopsy in negative bpMRI was only performed if digital rectal examination (DRE) was suspicious or PSA exceeded 10 ng/ml. RESULTS: In overall, 244 patients were included in the analysis. The median PSA was 1.33 ng/ml (IQR 0.75 – 2.88). In total, bpMRI detected suspicious PI-RADS lesions in 70 patients and biopsy was performed in 71 patients. We detected 6/26 (23.1 %) nonclinically relevant cancers (ISUP I) and 20/26 (76.9 %) clinically relevant cancers (ISUP≥II). All (20 / 20) of the clinically relevant cancers were detected by bpMRI while 50 % (10 / 20) would have been missed by PSA and digital rectal examination. CONCLUSIONS: Screening with bpMRI has the potential to detect prostate cancer otherwise missed by classical screening methods at a remarkably low PSA. This comes at the cost of the detection of nonclinically relevant PCa in 23.1 % of the patients and negative biopsies in 63.4 % of the patients. While this reflects probably a high sensitivity for the detection of clinically relevant PCa, the protocol may be refined using companion tests, like Stockholm 3 (SH3) in order to reduce imaging procedures and biopsies. Source of Funding: The study is funded by the Departments of Urology and Radiology at University Hospital Basel, Switzerland. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e763 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marc Matthias More articles by this author Christian Wetterauer More articles by this author Heike Püschel More articles by this author Helge Seifert More articles by this author Alexander Deckart More articles by this author David Jean Winkel More articles by this author Lukas Bubendorf More articles by this author Daniel Boll More articles by this author Elmar Merkle More articles by this author Cyrill Rentsch More articles by this author Expand All Advertisement PDF downloadLoading ...