Opportunistic Prostate Cancer Screening with Biparametric Magnetic Resonance Imaging (VISIONING)

Christian Wetterauer; Mark Matthias; Heike Pueschel; Alexander Deckart; Lukas Bubendorf; Ashkan Mortezavi; Emilio Arbelaez; David Jean Winkel; Tobias Heye; Daniel T Boll; Elmar Merkle; Stefanie Hayoz; Helge H Seifert; Cyrill A Rentsch

doi:10.1016/j.euf.2024.02.006

Opportunistic Prostate Cancer Screening with Biparametric Magnetic Resonance Imaging (VISIONING)

Eur Urol Focus. 2024 Feb 23:S2405-4569(24)00023-3. doi: 10.1016/j.euf.2024.02.006. Online ahead of print.

Authors

Affiliations

¹ Department of Urology, University Hospital Basel, Basel, Switzerland; Department of Medicine, Faculty of Medicine and Dentistry, Danube Private University, Krems, Austria; University of Basel, Basel, Switzerland.
² Department of Urology, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
³ Department of Urology, University Hospital Basel, Basel, Switzerland.
⁴ University of Basel, Basel, Switzerland; Institute of Pathology, University Hospital Basel, Basel, Switzerland.
⁵ University of Basel, Basel, Switzerland; Department of Radiology, University Hospital Basel, Basel, Switzerland.
⁶ Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland.
⁷ Department of Urology, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland. Electronic address: cyrill.rentsch@usb.ch.

PMID: 38402105
DOI: 10.1016/j.euf.2024.02.006

Abstract

Background: This study investigates the use of biparametric magnetic resonance imaging (bpMRI) as primary opportunistic screening for prostate cancer (PCa) without using a prostate-specific antigen (PSA) cut-off.

Objective: The primary endpoint was to assess the efforts and effectiveness of identifying 20 participants with clinically significant prostate cancer (csPCa) using bpMRI.

Design, setting, and participants: Biopsy-naïve men aged over 45 yr were included. All participants underwent 3 Tesla bpMRI, PSA, and digital rectal examination (DRE). Targeted-only biopsy was performed in participants with Prostate Imaging Reporting and Data System (PI-RADS) ≥3. Men with negative bpMRI but suspicious DRE or elevated PSA/PSA density had template biopsies. Preintended protocol adjustments were made after an interim analysis for PI-RADS 3 lesions: no biopsy and follow-up MRI after 6 mo and biopsy only if lesions persisted or upgraded.

Outcome measurements and statistical analysis: Biopsy results underwent a comparison using Fisher's exact test and univariable logistic regression to identify prognostic factors for positive biopsy.

Results and limitations: A total of 229 men were enrolled in this study, of whom 79 underwent biopsy. Among these men, 77 displayed suspicious PI-RADS lesions. PCa was detected in 29 participants (12.7%), of whom 21 had csPCa (9.2%). Biparametric MRI detected 21 csPCa cases, while PSA and DRE would have missed 38.1%. Protocol adjustment led to a 54.6% biopsy reduction in PI-RADS 3 lesions. Overall, in this cohort of men with a median PSA value of 1.26 ng/ml, 10.9 bpMRI scans were needed to identify one participant with csPCa. A major limitation of the study is the lack of a control cohort undergoing systematic biopsies.

Conclusions: Opportunistic screening utilising bpMRI as a primary tool has higher sensitivity in detecting csPCa than classical screening methods.

Patient summary: Screening with biparametric magnetic resonance imaging (bpMRI) and targeted biopsy identified clinically significant prostate cancer in every 11th man, regardless of the prostate-specific antigen (PSA) levels. Preselecting patients based on PSA >1 ng/ml and a positive family history of prostate cancer, as well as other potential blood tests may further improve the effectiveness of bpMRI in this setting.

Keywords: Magnetic resonance imaging; Prostate Imaging Reporting and Data System; Prostate biopsy; Prostate cancer; Prostate-specific antigen; Screening.