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In a Stockholm screening trial, sending men with a raised PSA for an MRI scan first, and biopsying only those whose scan looked suspicious, found as many important prostate cancers as biopsying all of them, and a third as many harmless ones.
A population-based non-inferiority trial from Karolinska Institutet. Men aged 50 to 74 were invited by post; of 12,750 enrolled, 1,532 had a PSA of 3 ng/mL or higher and were randomised 2:3 to standard biopsy (603) or to MRI with targeted and standard biopsy if the MRI suggested cancer (929). The primary outcome was the proportion with clinically significant cancer (Gleason score 7 or more) in the intention-to-treat population; the key secondary outcome was detection of clinically insignificant (Gleason 6) cancer.
Overdiagnosis, finding cancers that would never have caused harm, is the main reason Sweden's health authority advises against PSA screening. This trial showed that putting an MRI before the biopsy keeps the detection of cancers that matter while cutting the harmless ones by about two thirds. Sweden's regions have since begun organised prostate cancer testing, which the regional cancer centres describe as making PSA testing more equal and structured and helping to evaluate complementary tests; Socialstyrelsen still distinguishes it from screening.
Shares Henrik Grönberg, Martin Eklund, STHLM3-MRI (Stockholm3 and MRI-targeted biopsy in prostate cancer screening), Karolinska University Hospital.
Shares Multiparametric prostate MRI (PI-RADS), PSA and MRI-first prostate cancer screening, Overdiagnosis, PSA (prostate-specific antigen).
Shares Henrik Grönberg, Martin Eklund, New England Journal of Medicine.
Shares Overdiagnosis, PSA (prostate-specific antigen), Prostate cancer.
Shares Henrik Grönberg, Martin Eklund, Karolinska University Hospital.
Shares PSA and MRI-first prostate cancer screening, Overdiagnosis, PSA (prostate-specific antigen), The hardest cancers are found late.
Shares Multiparametric prostate MRI (PI-RADS), PSA and MRI-first prostate cancer screening, Prostate cancer.
Shares PSA and MRI-first prostate cancer screening, Overdiagnosis, PSA (prostate-specific antigen), The hardest cancers are found late.
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