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Eldred-Evans D, Burak P, Connor M, et al., 2021, Population-based prostate cancer screening with Magnetic Resonance Imaging or Ultrasonography: the IP1-PROSTAGRAM study, JAMA Oncology, Vol: 7, Pages: 395-402, ISSN: 2374-2445
Importance: Screening for prostate cancer using PSA-testing can lead to problems of under- and over-diagnosis. A short, non-contrast MRI or transrectal ultrasound might overcome these limitations. Objective: To compare the performance of PSA, MRI and ultrasound as screening tests for prostate cancer. Design, Setting and Participants: This prospective, population-based, blinded cohort study was conducted at seven primary care practices and two imaging centres in the UK. 2034 community based men aged 50-69 years invited for prostate cancer screening and 408 were consented. Interventions: All participants underwent screening with a PSA test, MRI (T2-weighted and diffusion) and ultrasound (b-mode and shearwave elastography).-The tests were independently interpreted without knowledge of other results. Both imaging tests were reported on a validated 5-point scale of suspicion. If any test was screen-positive, a systematic 12-core biopsy was performed. Additionalimage-fusion targeted biopsies were taken if the MRI or ultrasound was positive. Main Outcomes and Measures: The proportion of men with screen-positive MRI or ultrasound (defined as either score 3-5 or 4-5) or screen-positive PSA (defined as PSA≥3g/L). Key secondary outcomes were the number of clinically-significant and clinically-insignificant cancers detected if each test was used exclusively. Clinically-significant cancer was defined as any Gleason score≥3+4. Results: The proportion with a screen-positive MRI (score 3-5) was higher than the proportion with a screen-positive PSA (72/406, 17.7%[95%CI 14.3-21.8] vs. 40/406,9.9%[95%CI 7.3-13.2]; p<0.001). The proportion with a screen-positive ultrasound (score 3-5) was also higher than PSA (96/405, 23.7% [95%CI 19.8-28.1];p<0.001). For an imaging threshold of score 4-5, the proportion with a screen-positive MRI was similar to PSA (43/406, 10.6%[95%CI 7.9-13.2];p=0.71), as was the proportion with a screen-positive ultrasound (52/405, 12.8%[95%CI 9.9-16.5
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