Multiparametric Magnetic Resonance Imaging in Prostate Cancer Screening at the Age of 45 Years: Results from the First Screening Round of the PROBASE Trial.

Magnetic resonance imaging, Interventional Multiparametric magnetic resonance imaging Prostatic neoplasms Screening

Journal

European urology
ISSN: 1873-7560
Titre abrégé: Eur Urol
Pays: Switzerland
ID NLM: 7512719

Informations de publication

Date de publication:
18 Oct 2023
Historique:
received: 13 07 2023
revised: 05 09 2023
accepted: 28 09 2023
medline: 21 10 2023
pubmed: 21 10 2023
entrez: 20 10 2023
Statut: aheadofprint

Résumé

Magnetic resonance imaging (MRI) has been suggested as a tool for guiding biopsy recommendations in prostate cancer (PC) screening. To determine the performance of multiparametric MRI (mpMRI) in young men at age 45 yr who participated in a PC screening trial (PROBASE) on the basis of baseline prostate-specific antigen (PSA). Participants with confirmed PSA ≥3 ng/ml were offered mpMRI followed by MRI/transrectal ultrasound fusion biopsy (FBx) with targeted and systematic cores. mpMRI scans from the first screening round for men randomised to an immediate PSA test in PROBASE were evaluated by local readers and then by two reference radiologists (experience >10 000 prostate MRI examinations) blinded to the histopathology. The PROBASE trial is registered as ISRCTN37591328 OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The local and reference Prostate Imaging-Data and Reporting System (PI-RADS) scores were compared, and the sensitivity, negative predictive value (NPV), and accuracy were calculated for both readings for different cutoffs (PI-RADS 3 vs 4). Of 186 participants, 114 underwent mpMRI and FBx. PC was detected in 47 (41%), of whom 33 (29%) had clinically significant PC (csPC; International Society of Urological Pathology grade group ≥2). Interobserver reliability between local and reference PI-RADS scores was moderate (k = 0.41). At a cutoff of PI-RADS 4, reference reading showed better performance for csPC detection (sensitivity 79%, NPV 91%, accuracy of 85%) than local reading (sensitivity 55%, NPV 80%, accuracy 68%). Reference reading did not miss any PC cases for a cutoff of PI-RADS <3. If PI-RADS ≥4 were to be used as a biopsy cutoff, mpMRI would reduce negative biopsies by 68% and avoid detection of nonsignificant PC in 71% of cases. Prostate MRI in a young screening population is difficult to read. The MRI accuracy of for csPC detection is highly dependent on reader experience, and double reading might be advisable. More data are needed before MRI is included in PC screening for men at age 45 yr. Measurement of prostate specific antigen (PSA) is an effective screening test for early detection of prostate cancer (PC) and can reduce PC-specific deaths, but it can also lead to unnecessary biopsies and treatment. Magnetic resonance imaging (MRI) after a positive PSA test has been proposed as a way to reduce the number of biopsies, with biopsy only recommended for men with suspicious MRI findings. Our results indicate that MRI accuracy is moderate for men aged 45 years but can be increased by a second reading of the images by expert radiologists. For broad application of MRI in routine screening, double reading may be advisable.

Sections du résumé

BACKGROUND BACKGROUND
Magnetic resonance imaging (MRI) has been suggested as a tool for guiding biopsy recommendations in prostate cancer (PC) screening.
OBJECTIVE OBJECTIVE
To determine the performance of multiparametric MRI (mpMRI) in young men at age 45 yr who participated in a PC screening trial (PROBASE) on the basis of baseline prostate-specific antigen (PSA).
DESIGN, SETTING, AND PARTICIPANTS METHODS
Participants with confirmed PSA ≥3 ng/ml were offered mpMRI followed by MRI/transrectal ultrasound fusion biopsy (FBx) with targeted and systematic cores. mpMRI scans from the first screening round for men randomised to an immediate PSA test in PROBASE were evaluated by local readers and then by two reference radiologists (experience >10 000 prostate MRI examinations) blinded to the histopathology. The PROBASE trial is registered as ISRCTN37591328 OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The local and reference Prostate Imaging-Data and Reporting System (PI-RADS) scores were compared, and the sensitivity, negative predictive value (NPV), and accuracy were calculated for both readings for different cutoffs (PI-RADS 3 vs 4).
RESULTS AND LIMITATIONS CONCLUSIONS
Of 186 participants, 114 underwent mpMRI and FBx. PC was detected in 47 (41%), of whom 33 (29%) had clinically significant PC (csPC; International Society of Urological Pathology grade group ≥2). Interobserver reliability between local and reference PI-RADS scores was moderate (k = 0.41). At a cutoff of PI-RADS 4, reference reading showed better performance for csPC detection (sensitivity 79%, NPV 91%, accuracy of 85%) than local reading (sensitivity 55%, NPV 80%, accuracy 68%). Reference reading did not miss any PC cases for a cutoff of PI-RADS <3. If PI-RADS ≥4 were to be used as a biopsy cutoff, mpMRI would reduce negative biopsies by 68% and avoid detection of nonsignificant PC in 71% of cases.
CONCLUSIONS CONCLUSIONS
Prostate MRI in a young screening population is difficult to read. The MRI accuracy of for csPC detection is highly dependent on reader experience, and double reading might be advisable. More data are needed before MRI is included in PC screening for men at age 45 yr.
PATIENT SUMMARY RESULTS
Measurement of prostate specific antigen (PSA) is an effective screening test for early detection of prostate cancer (PC) and can reduce PC-specific deaths, but it can also lead to unnecessary biopsies and treatment. Magnetic resonance imaging (MRI) after a positive PSA test has been proposed as a way to reduce the number of biopsies, with biopsy only recommended for men with suspicious MRI findings. Our results indicate that MRI accuracy is moderate for men aged 45 years but can be increased by a second reading of the images by expert radiologists. For broad application of MRI in routine screening, double reading may be advisable.

Identifiants

DOI: 10.1016/j.eururo.2023.09.027 PMID: 37863727
pubmed: 37863727
pii: S0302-2838(23)03158-5
doi: 10.1016/j.eururo.2023.09.027
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Auteurs

Matthias Boschheidgen (M)

Dusseldorf University, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.

Peter Albers (P)

University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany; Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.

Heinz-Peter Schlemmer (HP)

Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.

Susanne Hellms (S)

Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.

David Bonekamp (D)

Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.

Andreas Sauter (A)

Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.

Boris Hadaschik (B)

Department of Urology, University of Duisburg-Essen and German Cancer Consortium (dktk), University Hospital Essen, Essen, Germany.

Agne Krilaviciute (A)

Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.

Jan Philipp Radtke (JP)

University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.

Petra Seibold (P)

Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.

Jale Lakes (J)

University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.

Christian Arsov (C)

University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany; Department of Urology and Paediatric Urology, Elisabeth-Krankenhaus Rheydt, Städtische Kliniken Mönchengladbach GmbH, Mönchengladbach, Germany.

Jürgen E Gschwend (JE)

Department of Urology, School of Medicine and Health, Technical University of Munich, Munich, Germany.

Kathleen Herkommer (K)

Department of Urology, School of Medicine and Health, Technical University of Munich, Munich, Germany.

Marcus Makowski (M)

Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.

Markus A Kuczyk (MA)

Department of Urology, Medical University Hannover, Hannover, Germany.

Frank Wacker (F)

Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.

Nina Harke (N)

Department of Urology, Medical University Hannover, Hannover, Germany.

Jürgen Debus (J)

Department of Radiation Oncology, Heidelberg University Hospital, Ruprecht Karls University, Heidelberg, Germany.

Stefan A Körber (SA)

Department of Radiation Oncology, Heidelberg University Hospital, Ruprecht Karls University, Heidelberg, Germany.

Axel Benner (A)

Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany.

Glen Kristiansen (G)

Institute of Pathology, University Hospital Bonn, Bonn, Germany.

Frederik L Giesel (FL)

University Dusseldorf, Medical Faculty, Department of Nuclear Medicine, D-40225 Dusseldorf, Germany.

Gerald Antoch (G)

Dusseldorf University, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany; Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, Düsseldorf (CIO ABCD), Germany.

Rudolf Kaaks (R)

Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.

Nikolaus Becker (N)

Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.

Lars Schimmöller (L)

Dusseldorf University, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany; Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany. Electronic address: lars.schimmoeller@med.uni-duesseldorf.de.

Classifications MeSH