Wallström Jonas, Geterud Kjell, Kohestani Kimia, Maier Stephan E, Pihl Carl-Gustaf, Socratous Andreas, Stranne Johan, Arnsrud-Godtman Rebecka, Månsson Marianne, Hellström Mikael, Hugosson Jonas
Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
Eur Urol Oncol. 2022 Feb;5(1):54-60. doi: 10.1016/j.euo.2021.09.001. Epub 2021 Sep 25.
The Göteborg 2 prostate cancer (PC) screening (G2) trial evaluates screening with prostate-specific antigen (PSA) followed by magnetic resonance imaging (MRI) in case of elevated PSA levels.
To assess the safety of using a 2-yr interval in men who were previously screened positive with PSA but had negative MRI or positive MRI with a negative biopsy.
DESIGN, SETTING, AND PARTICIPANTS: A total of 61 201 men aged 50-60 yr were randomized and 38 366 were invited for screening (years 2015-2020). Men with positive MRI (Prostate Imaging Reporting and Data System [PI-RADS] score ≥3) were scheduled for targeted biopsies. Men with negative MRI or negative biopsies were reinvited after 2 yr. Round 1 and 2 MRI scans (PI-RADS ≥3) of men not diagnosed with PC in round 1 were re-read and classified according to Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) by two radiologists. Interval PCs (detected outside the program before invitation to round 2) were identified by linking to the Regional PC Registry.
Tabulation of overall detection of PC was done.
Between October 2017 and June 2020, 474 men with round 1 elevated PSA and MRI underwent a second screening. Of those, 19% had nonelevated PSA in round 2 and were not examined further. Of the remaining 376 men, 89% had negative MRI. Targeted biopsies yielded 14 PCs: nine grade group (GG) 1 and five GG 2-3. In men with PI-RADS ≥3 and PC diagnosed in round 2, only two (GG 1) progressed according to the PRECISE criteria and the remainder were stable. Ten interval PCs were diagnosed: seven GG 1, one GG 2, and two GG 5. The two GG 5 PCs were PI-RADS 4 and 5 with negative round 1 biopsy.
A 2-yr interval seems to be safe in men with negative MRI, while men with PI-RADS 4 and 5 lesions with negative biopsies should have a closer follow-up.
In prostate cancer screening, a 2-yr follow-up seems to be safe if magnetic resonance imaging did not show highly suspicious findings.
哥德堡2期前列腺癌（PC）筛查（G2）试验评估了采用前列腺特异性抗原（PSA）进行筛查，若PSA水平升高则随后进行磁共振成像（MRI）检查的效果。
评估对于既往PSA筛查呈阳性但MRI结果为阴性或MRI结果为阳性但活检结果为阴性的男性，采用2年间隔进行筛查的安全性。
设计、地点和参与者：共有61201名年龄在50至60岁的男性被随机分组，38366名男性被邀请参加筛查（2015年至2020年）。MRI结果为阳性（前列腺影像报告和数据系统[PI-RADS]评分≥3）的男性被安排进行靶向活检。MRI结果为阴性或活检结果为阴性的男性在2年后再次被邀请参加筛查。对第一轮未被诊断为PC的男性的第一轮和第二轮MRI扫描（PI-RADS≥3）由两名放射科医生重新阅片，并根据前列腺癌连续评估中的放射学变化估计（PRECISE）进行分类。通过与地区PC登记处的数据链接，识别出间隔期PC（在第二轮邀请之前在项目外检测到的）。
对PC的总体检测情况进行列表统计。
在2017年10月至2020年6月期间，474名第一轮PSA和MRI结果异常的男性接受了第二次筛查。其中，19%的男性在第二轮筛查时PSA水平正常，未进一步检查。在其余376名男性中，89%的MRI结果为阴性。靶向活检发现了14例PC：9例为1级组（GG），5例为2-3级组。在第二轮诊断为PC且PI-RADS≥3的男性中，根据PRECISE标准，只有2例（GG 1）病情进展，其余病情稳定。诊断出10例间隔期PC：7例为GG 1，1例为GG 2，2例为GG 5。2例GG 5级PC的PI-RADS评分为4和5，第一轮活检结果为阴性。
对于MRI结果为阴性的男性，2年的间隔期似乎是安全的，而对于活检结果为阴性的PI-RADS 4和5级病变男性，应进行更密切的随访。
在前列腺癌筛查中，如果磁共振成像未显示高度可疑的结果，2年的随访似乎是安全的。
