Grenabo Bergdahl Anna, Wilderäng Ulrica, Aus Gunnar, Carlsson Sigrid, Damber Jan-Erik, Frånlund Maria, Geterud Kjell, Khatami Ali, Socratous Andreas, Stranne Johan, Hellström Mikael, Hugosson Jonas
Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Eur Urol. 2016 Oct;70(4):566-573. doi: 10.1016/j.eururo.2015.12.006. Epub 2015 Dec 24.
Magnetic resonance imaging (MRI) and targeted biopsies (TB) have shown potential to more accurately detect significant prostate cancer compared with prostate-specific antigen (PSA) and systematic biopsies (SB).
To compare sequential screening (PSA+MRI) with conventional PSA screening.
DESIGN, SETTING, AND PARTICIPANTS: Of 384 attendees in the 10th screening round of the Göteborg randomised screening trial, 124 men, median age 69.5 yr, had a PSA of ≥ 1.8 ng/ml and underwent a prebiopsy MRI. Men with suspicious lesions on MRI and/or PSA ≥ 3.0ng/ml were referred for biopsy. SB was performed blinded to MRI results and TB was performed in men with tumour-suspicious findings on MRI. Three screening strategies were compared (PSA ≥ 3.0+SB; PSA ≥ 3.0+MRI+TB and PSA ≥ 1.8+MRI+TB).
Cancer detection rates, sensitivity, and specificity were calculated per screening strategy and compared using McNemar's test.
In total, 28 cases of prostate cancer were detected, of which 20 were diagnosed in biopsy-naïve men. Both PSA ≥ 3.0+MRI and PSA ≥ 1.8+MRI significantly increased specificity compared with PSA ≥ 3.0+SB (0.92 and 0.79 vs 0.52; p<0.002 for both), while sensitivity was significantly higher for PSA ≥ 1.8+MRI compared with PSA ≥ 3.0+MRI (0.73 vs 0.46, p=0.008). The detection rate of significant cancer was higher with PSA ≥ 1.8+MRI compared with PSA ≥ 3.0+SB (5.9% vs 4.0%), while the detection rate of insignificant cancer was lowered by PSA ≥ 3.0+MRI (0.3% vs 1.2%). The primary limitation of this study is the small sample of men.
A screening strategy with a lowered PSA cut-off followed by TB in MRI-positive men seems to increase the detection of significant cancers while improving specificity. If replicated, these results may contribute to a paradigm shift in future screening.
Major concerns in prostate-specific antigen screening are overdiagnosis and underdiagnosis. We evaluated whether prostate magnetic resonance imaging could improve the balance of benefits to harm in prostate cancer screening screening, and we found a promising potential of using magnetic resonance imaging in addition to prostate-specific antigen.
与前列腺特异性抗原（PSA）和系统活检（SB）相比，磁共振成像（MRI）和靶向活检（TB）已显示出更准确检测显著前列腺癌的潜力。
比较序贯筛查（PSA+MRI）与传统PSA筛查。
设计、设置和参与者：在哥德堡随机筛查试验的第10轮筛查中，384名参与者中有124名男性，中位年龄69.5岁，PSA≥1.8 ng/ml，并在活检前接受了MRI检查。MRI上有可疑病变和/或PSA≥3.0 ng/ml的男性被转诊进行活检。SB在对MRI结果不知情的情况下进行，TB在MRI上有肿瘤可疑发现的男性中进行。比较了三种筛查策略（PSA≥3.0+SB；PSA≥3.0+MRI+TB和PSA≥1.8+MRI+TB）。
计算每种筛查策略的癌症检测率、敏感性和特异性，并使用McNemar检验进行比较。
总共检测到28例前列腺癌，其中20例在未进行过活检的男性中被诊断出来。与PSA≥3.0+SB相比，PSA≥3.0+MRI和PSA≥1.8+MRI均显著提高了特异性（分别为0.92和0.79，而PSA≥3.0+SB为0.52；两者p<0.002），而与PSA≥3.0+MRI相比，PSA≥1.8+MRI的敏感性显著更高（0.73对0.46，p=0.008）。与PSA≥3.0+SB相比，PSA≥1.8+MRI对显著癌症的检测率更高（5.9%对4.0%），而PSA≥3.0+MRI降低了对非显著癌症的检测率（0.3%对1.2%）。本研究的主要局限性是男性样本量小。
一种降低PSA临界值并对MRI阳性男性进行TB的筛查策略似乎可以增加对显著癌症的检测，同时提高特异性。如果得到重复验证，这些结果可能会导致未来筛查模式的转变。
前列腺特异性抗原筛查中的主要问题是过度诊断和诊断不足。我们评估了前列腺磁共振成像是否可以改善前列腺癌筛查中利弊的平衡，并且我们发现除前列腺特异性抗原外使用磁共振成像具有有前景的潜力。
