Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Sci Rep. 2021 Jan 19;11(1):1801. doi: 10.1038/s41598-021-81459-2.
The benefit of prostate cancer screening is counterbalanced by the risk of overdiagnosis and overtreatment. The use of a multi-parametric magnetic resonance imaging (mpMRI) test after a positive prostate-specific antigen (PSA) test followed by magnetic resonance imaging-guided biopsy (MRIGB) may reduce these harms. The aim of this study was to determine the effects of mpMRI and MRIGB vs the regular screening pathway in a population-based prostate cancer screening setting. A micro-simulation model was used to predict the effects of regular PSA screening (men with elevated PSA followed by TRUSGB) and MRI based screening (men with elevated PSA followed by mpMRI and MRIGB). We predicted reduction of overdiagnosis, harm-benefit ratio (overdiagnosis per cancer death averted), reduction in number of biopsies, detection of clinically significant cancer, prostate cancer death averted, life-years gained (LYG), and quality adjusted life years (QALYs) gained for both strategies. A univariate sensitivity analysis and threshold analysis were performed to assess uncertainty around the test sensitivity parameters used in the MRI strategy.In the MRI pathway, we predicted a 43% reduction in the risk of overdiagnosis, compared to the regular pathway. Similarly a lower harm-benefit ratio (overdiagnosis per cancer death averted) was predicted for this strategy compared to the regular screening pathway (1.0 vs 1.8 respectively). Prostate cancer mortality reduction, LY and QALYs gained were also slightly increased in the MRI pathway than the regular screening pathway. Furthermore, 30% of men with a positive PSA test could avoid a biopsy as compared to the regular screening pathway. Compared to regular PSA screening, the use of mpMRI as a triage test followed by MRIGB can substantially reduce the risk of overdiagnosis and improve the harm-benefit balance, while maximizing prostate cancer mortality reduction and QALYs gained.
前列腺癌筛查的益处被过度诊断和过度治疗的风险所抵消。在前列腺特异性抗原（PSA）检测阳性后，使用多参数磁共振成像（mpMRI）检测，然后进行磁共振成像引导下的活检（MRIGB），可能会降低这些危害。本研究旨在确定在基于人群的前列腺癌筛查环境中，mpMRI 和 MRIGB 与常规筛查途径的效果。使用微模拟模型预测常规 PSA 筛查（PSA 升高的男性进行经直肠超声引导下的活检）和基于 MRI 的筛查（PSA 升高的男性进行 mpMRI 和 MRIGB）的效果。我们预测了过度诊断的减少、危害-效益比（每例癌症死亡避免的过度诊断）、活检次数的减少、临床显著癌症的检出、前列腺癌死亡的避免、寿命的增加（LYG）以及两种策略的质量调整寿命年（QALYs）的增加。进行了单变量敏感性分析和阈值分析，以评估 MRI 策略中使用的测试灵敏度参数的不确定性。在 MRI 途径中，我们预测与常规途径相比，过度诊断的风险降低了 43%。同样，与常规筛查途径相比，该策略的危害-效益比（每例癌症死亡避免的过度诊断）也较低（分别为 1.0 和 1.8）。与常规筛查途径相比，MRI 途径的前列腺癌死亡率降低、寿命和 QALYs 也略有增加。此外，与常规筛查途径相比，30%的 PSA 检测阳性的男性可以避免进行活检。与常规 PSA 筛查相比，使用 mpMRI 作为分诊检测，然后进行 MRIGB，可以显著降低过度诊断的风险，改善危害-效益平衡，同时最大限度地降低前列腺癌死亡率和提高 QALYs。
