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Clinically Significant Prostate Cancer Uncommon At Repeat MRI Screening – Renal And Urology News –

Among men receiving their second biennial prostate cancer screening in a Swedish study, less than 3% of those with prior negative MRI findings had lesions suspicious for prostate cancer found on repeat MRI screening, according to investigators.

The finding is from a secondary analysis of the STHLM3-MRI randomized clinical trial. Of 1500 men who were rescreened, investigators found clinically significant prostate cancer (Gleason score of 3+4 or higher) in only 3.2% and clinically insignificant cancer (Gleason score of 6) in 0.7%.

“The high proportion of negative MRI results is striking, and it would lead to an overutilization of MRI resources if used for biannual prostate cancer screening in combination with PSA levels of 3 ng/mL or greater as the cutoff for a single-biomarker strategy for further workup,” Tobias Nordström, MD, PhD, of Karolinska Institutet in Stockholm, Sweden, and colleagues reported in JAMA Network Open. “This supports the use of reflex testing in men with moderately elevated PSA levels in a screening program.”

The 1500 men had an initial PSA level of at least 1.5 ng/mL and had a repeat PSA test at 2 to 3 years after their first screening. Of these, 667 men (44.5%) had PSA levels of 3 ng/mL or greater, and 617 (92.5%) underwent biparametric MRI. Men with lesions with a PI-RADS score of 3 or greater were referred for targeted and systematic biopsies.

Results showed that 51 men (7.6%) had equivocal PI-RADS score 3 lesions and only 33 men (4.9%) had suspicious lesions (PI-RADS score 4 or higher). Only 10 of 383 men (2.6%) with a prior negative MRI result had a lesion with a PI-RADS score of 4 or greater.

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“A substantial proportion of men exhibited elevated PSA levels during rescreening, and a considerable portion of MRI scans performed lacked lesions suggestive of cancer. Future studies should explore strategies to reduce MRI-related resource use,” the investigators concluded.