Moore Caroline M, Frangou Elena, McCartan Neil, Santaolalla Aida, Kopcke Douglas, Brembilla Giorgio, Hadley Joanna, Giganti Francesco, Marsden Teresa, Van Hemelrijck Mieke, Gong Fiona, Freeman Alex, Haider Aiman, Tuck Steve, Pashayan Nora, Callender Thomas, Green Saran, Brown Louise C, Punwani Shonit, Emberton Mark
Division of Surgery & Interventional Science, University College London, London, UK.
Urology, University College London Hospitals NHS Foundation Trust, London, UK.
BMJ Oncol. 2023 Aug 21;2(1):e000057. doi: 10.1136/bmjonc-2023-000057. eCollection 2023.
In men with a raised prostate-specific antigen (PSA), MRI increases the detection of clinically significant cancer and reduces overdiagnosis, with fewer biopsies. MRI as a screening tool has not been assessed independently of PSA in a formal screening study. We report a systematic community-based assessment of the prevalence of prostate MRI lesions in an age-selected population.
Men aged 50-75 were identified from participating general practice (GP) practices and randomly selected for invitation to a screening MRI and PSA. Men with a positive MRI or a raised PSA density (≥0.12 ng/mL) were recommended for standard National Health Service (NHS) prostate cancer assessment.
Eight GP practices sent invitations to 2096 men. 457 men (22%) responded and 303 completed both screening tests. Older white men were most likely to respond to the invitation, with black men having 20% of the acceptance rate of white men.One in six men (48/303 men, 16%) had a positive screening MRI, and an additional 1 in 20 men (16/303, 5%) had a raised PSA density alone. After NHS assessment, 29 men (9.6%) were diagnosed with clinically significant cancer and 3 men (1%) with clinically insignificant cancer.Two in three men with a positive MRI, and more than half of men with clinically significant disease had a PSA <3 ng/mL.
Prostate MRI may have value in screening independently of PSA. These data will allow modelling of the use of MRI as a primary screening tool to inform larger prostate cancer screening studies.
NCT04063566.
对于前列腺特异性抗原（PSA）升高的男性，磁共振成像（MRI）可提高临床显著性癌症的检出率，减少过度诊断，且活检次数更少。在一项正式的筛查研究中，尚未独立于PSA对MRI作为一种筛查工具进行评估。我们报告了一项基于社区的、对特定年龄人群前列腺MRI病变患病率的系统评估。
从参与研究的全科医生（GP）诊所中识别出年龄在50 - 75岁的男性，并随机邀请他们进行筛查MRI和PSA检测。MRI阳性或PSA密度升高（≥0.12 ng/mL）的男性被建议进行标准的英国国家医疗服务体系（NHS）前列腺癌评估。
8家GP诊所向2096名男性发出邀请。457名男性（22%）做出回应，303名完成了两项筛查测试。年龄较大的白人男性最有可能回应邀请，黑人男性的接受率为白人男性的20%。六分之一的男性（48/303名男性，16%）筛查MRI呈阳性，另外二十分之一的男性（16/303，5%）仅PSA密度升高。经过NHS评估，29名男性（9.6%）被诊断为临床显著性癌症，3名男性（1%）被诊断为临床非显著性癌症。三分之二的MRI阳性男性以及超过一半的临床显著性疾病男性PSA<3 ng/mL。
前列腺MRI可能在独立于PSA的筛查中具有价值。这些数据将有助于对MRI作为主要筛查工具的使用进行建模，为更大规模的前列腺癌筛查研究提供参考。
NCT04063566。
