PSA and MRI Prostate Cancer Screening | NEJM

Summary

A study involving 13,153 men aged 50-60 suggests that performing prostate biopsies only in those with elevated PSA levels and MRI-visible lesions could reduce overdiagnosis of clinically insignificant prostate cancer. This approach lowered the risk of detecting such cancers by 57% without missing significant cancers, according to a trial published on NEJM.org.

Takeaways

• 🔍 **Overdiagnosis Issue**: Many prostate cancer diagnoses based on elevated PSA levels may be clinically insignificant and not life-threatening.
• 💉 **PSA and MRI Criteria**: The study focuses on men with elevated PSA levels and visible lesions on MRI for prostate biopsies.
• 👨‍🔬 **Trial Design**: A randomized, prospective, population-based trial involving 13,153 men aged 50 to 60.
• 📊 **PSA Threshold**: Men with a PSA level of 3 ng/mL or higher underwent prostate MRI.
• 🧬 **Biopsy Methods**: Participants were divided into groups for systematic biopsy with MRI-targeted biopsy or MRI-targeted biopsy alone.
• 🔄 **Screening Frequency**: Repeat screenings were scheduled every 2, 4, or 8 years based on PSA levels.
• 📉 **Risk Reduction**: The MRI-targeted biopsy group had a 57% lower risk of detecting clinically insignificant cancer compared to the systematic biopsy group.
• 🏥 **Clinically Significant Cancer**: The diagnosis rate of clinically significant cancer was similar in both groups.
• 🚑 **Adverse Events**: Five severe adverse events leading to hospitalization occurred, likely related to biopsy procedures.
• 📝 **Conclusion**: Omitting systematic prostate biopsy in men with elevated PSA and negative MRI results reduces overdiagnosis without missing significant cancers.

Q & A

What is the issue with diagnosing prostate cancer based on elevated PSA levels alone?

Diagnosing prostate cancer based solely on elevated PSA levels can lead to overdiagnosis, where patients are diagnosed with clinically insignificant disease that will never progress to become a threat to their lives.

What is the potential harm of treating clinically insignificant prostate cancer?

Treating patients with clinically insignificant prostate cancer can result in substantial life-altering side effects without the prospect of extending their lives.

What was the aim of the new study mentioned in the script?

The aim of the study was to determine whether performing prostate biopsies only in men with elevated PSA levels and visible lesions on MRI could reduce overdiagnosis without missing clinically important prostate cancers.

How many participants were involved in the study?

The study involved 13,153 men aged 50 to 60 years.

What were the two groups in the study?

The participants were divided into two groups: one that underwent systematic biopsy and targeted biopsy if suspicious lesions were found on MRI, and another that only underwent MRI-targeted biopsy.

What were the intervals for repeat screenings in the study?

Repeat screenings occurred every 2, 4, or 8 years, depending on the participants' PSA levels.

What was the median follow-up period for the study?

The median follow-up period was 3.9 years.

What was the outcome for the MRI-targeted biopsy group regarding the risk of clinically insignificant cancer detection?

The MRI-targeted biopsy group had a 57% lower risk of clinically insignificant cancer being detected at screening or as interval cancer compared to the systematic biopsy group.

Was there a difference in the diagnosis of clinically significant cancer between the two groups?

The percentage of men diagnosed with clinically significant cancer was similar in both groups.

What was the incidence of severe adverse events related to biopsy in the study?

Five severe adverse events leading to hospitalization occurred, with four likely related to biopsy.

What is the conclusion of the study regarding systematic prostate biopsy for men with elevated PSA levels and negative MRI results?

The study concluded that omitting systematic prostate biopsy for men with elevated PSA levels and negative MRI results reduced diagnoses of clinically insignificant prostate cancer, and the associated risk of having incurable cancer diagnosed at screening or as interval cancer was very low.