The impact of pre‐biopsy MRI and additional testing on prostate cancer screening outcomes: A rapid review

Abstract

ObjectiveThis work aims to examine the latest evidence on the impact of pre‐biopsy MRI, in addition to prostate‐specific antigen (PSA) testing, on health outcomes and quality of life.MethodsWe conducted a literature search including PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) databases, with a limited scan of (i) guidelines and (ii) references from trial reports, from January 2005 to 25th January 2023. Two independent reviewers selected randomised controlled trials (RCT) and cohort studies which met our inclusion criteria.ResultsOne hundred thirty‐seven articles were identified, and seven trial articles were selected. Trial interventions were as follows: (i) PSA blood test, (ii) additional tests such as pre‐biopsy multiparametric magnetic resonance imaging (mpMRI) and Biparametric MRI (bpMRI), and (iii) MRI targeted biopsy and standard biopsy. Compared with standard biopsy, MRI‐based interventions led to increased detection of clinically significant cancers in three studies and decreased detection of clinically insignificant cancer (Gleason grade 3 + 3) in four studies. However, PROstate Magnetic resonance Imaging Study (PROMIS) and Stockholm3 with MRI (STHLM3‐MRI) studies reported different trends depending on the scenario studied in PROMIS (MRI triage and MRI directed biopsy vs. MRI triage and standard biopsy) and thresholds used in STHLM3‐MRI (≥0·11 and ≥0·15). MRI also helped 8%–49% of men avoid biopsy, in six out of seven studies, but not in STHLM3‐MRI at ≥0.11. Interestingly, the proportion of men who experienced sepsis and UTI was low across studies.ConclusionThis review found that a combination of approaches, centred on the use of pre‐biopsy MRI, may improve the detection of clinically significant cancers and reduce (i) the diagnosis of clinically insignificant cancers and (ii) unnecessary biopsies, compared with PSA testing and standard biopsy alone. However, the impact of such interventions on longer term outcomes such as prostate cancer‐specific mortality has not yet been assessed.

Optimising the use of the prostate- specific antigen blood test in asymptomatic men for early prostate cancer detection in primary care: report from a UK clinical consensus

“… 20 And have benefits and harms of PSA-based prostate cancer screening changed since the introduction of prebiopsy mpMRI and additional testing into the prostate cancer pathway? 14 Review of worldwide PSA testing guidelines (see Supplementary Table S1). Rapid reviews, guidelines review, and previous PSA consensus were used to draft 94 statements over five topics: awareness raising, discussions about PSA testing, and informed choice ( n = 25); PSA testing and referral for further investigation ( n = 45); role of digital rectal examination (DRE) and patient medical history in decision making ( n = 8); UK readiness for a targeted prostate cancer screening programme ( n = 13); and research opportunities and priorities ( n = 3).…”

“… 20 And have benefits and harms of PSA-based prostate cancer screening changed since the introduction of prebiopsy mpMRI and additional testing into the prostate cancer pathway? 14 …”

“…Second, use of mpMRI to target prostate biopsies may improve detection of clinically significant prostate cancers compared with systematic biopsies, 13 although long-term outcomes data are lacking. 14 Third, increased uptake of active surveillance in low- and intermediate-risk disease may allow some patients to delay or avoid radical treatment, potentially reducing overtreatment. 15 These changes have led professional bodies, such as the European Association of Urology, to change their view on PSA-based screening.…”