Multiparametric Magnetic Resonance Imaging in Prostate Cancer Screening at the Age of 45 Years: Results from the First Screening Round of the PROBASE Trial

• Published in: European urology 2024-02, Vol.85 (2), p.105-111
• Main Authors: Boschheidgen, Matthias, Albers, Peter, Schlemmer, Heinz-Peter, Hellms, Susanne, Bonekamp, David, Sauter, Andreas, Hadaschik, Boris, Krilaviciute, Agne, Radtke, Jan Philipp, Seibold, Petra, Lakes, Jale, Arsov, Christian, Gschwend, Jürgen E, Herkommer, Kathleen, Makowski, Marcus, Kuczyk, Markus A, Wacker, Frank, Harke, Nina, Debus, Jürgen, Körber, Stefan A, Benner, Axel, Kristiansen, Glen, Giesel, Frederik L, Antoch, Gerald, Kaaks, Rudolf, Becker, Nikolaus, Schimmöller, Lars
• Format: Article
• Language: English
• Subjects: Early Detection of Cancer; Humans; Image-Guided Biopsy - methods; Magnetic Resonance Imaging - methods; Male; Middle Aged; Multiparametric Magnetic Resonance Imaging; Polymethyl Methacrylate; Prostate-Specific Antigen; Prostatic Neoplasms - pathology; Reproducibility of Results
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2023.09.027

Magnetic resonance imaging (MRI) has been suggested as a tool for guiding biopsy recommendations in prostate cancer (PC) screening. To determine the performance of multiparametric MRI (mpMRI) in young men at age 45 yr who participated in a PC screening trial (PROBASE) on the basis of baseline prostate-specific antigen (PSA). Participants with confirmed PSA ≥3 ng/ml were offered mpMRI followed by MRI/transrectal ultrasound fusion biopsy (FBx) with targeted and systematic cores. mpMRI scans from the first screening round for men randomised to an immediate PSA test in PROBASE were evaluated by local readers and then by two reference radiologists (experience >10 000 prostate MRI examinations) blinded to the histopathology. The PROBASE trial is registered as ISRCTN37591328 OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The local and reference Prostate Imaging-Data and Reporting System (PI-RADS) scores were compared, and the sensitivity, negative predictive value (NPV), and accuracy were calculated for both readings for different cutoffs (PI-RADS 3 vs 4). Of 186 participants, 114 underwent mpMRI and FBx. PC was detected in 47 (41%), of whom 33 (29%) had clinically significant PC (csPC; International Society of Urological Pathology grade group ≥2). Interobserver reliability between local and reference PI-RADS scores was moderate (k = 0.41). At a cutoff of PI-RADS 4, reference reading showed better performance for csPC detection (sensitivity 79%, NPV 91%, accuracy of 85%) than local reading (sensitivity 55%, NPV 80%, accuracy 68%). Reference reading did not miss any PC cases for a cutoff of PI-RADS