For men with germline mutations, MRI-based screening increases prostate cancer detection while cutting down on the number of unnecessary prostate biopsies, investigators report.
In the PROGRESS prostate cancer screening trial, 101 male germline carriers of a likely pathogenic variant in at least 1 of the 19 prostate cancer risk genes have completed the first round of screening so far. BRCA2, BRCA1, and ATM were the most commonly found variants. The men, aged 35-74 years, received annual PSA screening and digital rectal examination (DRE) with multiparametric MRI (mpMRI) of the prostate every 3 years.
Of the 101 men, 21 had an elevated age-adjusted PSA, abnormal DRE, or suspicious mpMRI and underwent a biopsy. Age-adjusted PSA thresholds were more than 1.5 ng/mL for men 35-49 years, 2.0 ng/mL for 50-54 years, and 3.0 ng/mL for 55-74 years. Of the 9 cancer cases, 7 were clinically significant with a PIRADS score of 3 or higher.
In this high-risk cohort, mpMRI showed 100% sensitivity and a 100% negative predictive value for prostate cancer detection on biopsy, whereas PSA-based screening alone had 57% sensitivity with a negative predictive value of 73%, Keyan Salari, MD, PhD, of Massachusetts General Hospital in Boston, and colleagues reported in European Urology Oncology.
According to the investigators, “MRI-based screening alone achieved superior net benefit at all threshold probabilities compared with PSA screening—detecting one additional cancer case per 7.5 patients, while avoiding more unnecessary biopsies at the same threshold probability.”
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They noted that no cancers were diagnosed among the 5 patients aged 35-39 years reinforcing screening initiation at the age of 40 years.
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