5MinuteConsult Journal Club

MRI for Elevated Screening PSA

Reference 

NEJM July 9, 2021; DOI: 10.1056/NEJMoa2100852\

Study Summary

Study of ~1,500 Swedish men 50 to 74 years who had screening prostate-specific antigen (PSA) levels of >/= 3 ng/ml were randomly assigned to trans rectal ultrasound guided biopsy (6 per lobe; total 12 biopsies) or undergo prostate MRI with targeted biopsy of suspicious areas (if present) along with standard biopsy.

Outcomes

36% of the MRI participants underwent biopsies based upon PI-RADS (Prostate Imaging-Reporting and Data System (PI-RADS) scores of 3 or higher, Stockholm3 results (Stockholm3 test (STHLM3) is a blood test by means of which it is possible to assess the risk of prostate cancer better than with a mere PSA test.) and on the basis of the judgment of the study physician

A lower proportion of patients in the MRI group than in the standard group underwent biopsy (36% vs. 73%).  This reduced the biopsy rate by 50%

In the intention-to-treat analysis, clinically significant cancer was diagnosed in 21% in the MRI biopsy group vs 18% in the standard biopsy group (difference, 3 percentage points; 95% confidence interval [CI], −1 to 7; P<0.001 for noninferiority) showing improved positive predictive value.  

Conclusions

In men who have a PSA level >/= 3 ng/ml, obtaining an MRI prior to trans rectal ultrasound guided biopsy can improve stratifying who benefits from TRUS and direct biopsy when they are needed.  

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