MRI as a screening tool for prostate cancer: current evidence and future challenges

• Published in: World journal of urology 2023-04, Vol.41 (4), p.921-928
• Main Authors: Würnschimmel, Christoph, Chandrasekar, Thenappan, Hahn, Luisa, Esen, Tarik, Shariat, Shahrokh F., Tilki, Derya
• Format: Article
• Language: English
• Subjects: Cancer screening; Deep learning; Early Detection of Cancer - methods; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical screening; Medicine; Medicine & Public Health; Mortality; Nephrology; Oncology; Prospective Studies; Prostate cancer; Prostate-Specific Antigen; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Radiomics; Topic Paper; Urology
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-022-03947-y

Purpose Prostate cancer (PCa) screening, which relies on prostate-specific antigen (PSA) testing, is a contentious topic that received negative attention due to the low sensitivity and specificity of PSA to detect clinically significant PCa. In this context, due to the higher sensitivity and specificity of magnetic resonance imaging (MRI), several trials investigate the feasibility of “MRI-only” screening approaches, and question if PSA testing may be replaced within prostate cancer screening programs. Methods This narrative review discusses the current literature and the outlook on the potential of MRI-based PCa screening. Results Several prospective randomized population-based trials are ongoing. Preliminary study results appear to favor the “MRI-only” approach. However, MRI-based PCa screening programs face a variety of obstacles that have yet to be fully addressed. These include the increased cost of MRI, lack of broad availability, differences in MRI acquisition and interpretation protocols, and lack of long-term impact on cancer-specific mortality. Partly, these issues are being addressed by shorter and simpler MRI approaches (5–20 min bi-parametric MRI), novel quality indicators (PI-QUAL) and the implementation of radiomics (deep learning, machine learning). Conclusion Although promising preliminary results were reported, MRI-based PCa screening still lack long-term data on crucial endpoints such as the impact of MRI screening on mortality. Furthermore, the issues of availability, cost-effectiveness, and differences in MRI acquisition and interpretation still need to be addressed.