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August 2023 | George M. Pikler, M.D., Ph.D., FACP

Screening MRI Improves Prostate Cancer Diagnosis

A clinical trial conducted by U.K. researchers has found that screening MRI improves prostate cancer diagnosis. The study published in BMJ Oncology (1) found that MRI catches prostate cancer in men who have prostate-specific antigen (PSA) density levels below the follow-up benchmark of 3ng/ml (4.0ng/ml in the USA). According to Caroline Moore, MD, the lead investigator of University College London (UCL), “the thought that over half the men with clinically significant cancer had a PSA of less than 3 ng/ml and would have been reassured that they didn’t have cancer by a PSA test alone is a sobering one and reiterates the need to consider a new approach to prostate cancer screening.”

Typically, men are screened for prostate cancer with a PSA test and a digital rectal exam (DRE), followed by biopsy if disease is suspected. This approach has been shown to reduce mortality from the disease by 20%, but it has also been associated with overdiagnosis and overtreatment of low-risk cancers.

The trial, called ReIMAGINE, is the first to use MRI scans to assess PSA density — and thus determine if further testing is needed, according to UCL. The investigators included data from 303 men between the ages of 50 and 75 who upon invitation to screening underwent both an MRI exam and a PSA test. 16% of these men had a positive screening MRI exam strongly suggestive of prostate cancer, even though they had median PSA density results of 1.2 ng/ml, a score that would not have consider further testing necessary. (PSA levels above 3 ng/ml prompt additional diagnostic measures such as biopsy). In fact, 32 of the 303 men had PSA levels lower than 3 ng/ml, “meaning they would not have been referred for further investigation by the PSA test currently in use,” the group noted. The team also found that 29 patients had prostate cancer that required treatment, and of these, 15 had a PSA score below 3 ng/ml.

“Our results give an early indication that MRI could offer a more reliable method of detecting potentially serious cancers early, with the added benefit that less than one per cent of participants were ‘over-diagnosed’ with low-risk disease,” Moore said.

MRI as a triage test between a raised PSA or an abnormal DRE, and a biopsy, is currently recommended by the American Urology Association.

(1) BMJ Oncology. 2023, August 21; 2: e000057
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Erica

Erica Cross, PA

PA

Erica is a board certified Physician Assistant. She obtained her Master’s degree in Physician Assistant studies from Our Lady of the Lake College in Baton Rouge, LA. She began practicing in 2011 and has worked clinically in Orthopedics and Dermatology. The majority of her career has been spent in a Dermatology practice where she assisted in Mohs surgery, treating various types of skin cancer. She also teaches in the medical simulation department at the University of South Alabama and enjoys every aspect of medical education.