Prevalence of MRI lesions in men responding to a GP-led invitation for a prostate health check: a prospective cohort study
Caroline M. Moore, Eleni Frangou, Neil McCartan, Aida Santaolalla, Douglas Kopcke, Giorgio Brembilla, Joanna Hadley, Francesco Giganti, Teresa Marsden, Mieke Van Hemelrijck, Fiona Gong, Alex Freeman, Aiman Haider, Steve Tuck, Nora Pashayan, Thomas Callender, Saran Green, Louise Brown, Shonit Punwani, Mark Emberton
Abstract
Objective: In men with a raised prostate-specific antigen (PSA), MRI increases the detection of clinically significant cancer and reduces overdiagnosis, with fewer biopsies. MRI as a screening tool has not been assessed independently of PSA in a formal screening study. We report a systematic community-based assessment of the prevalence of prostate MRI lesions in an age-selected population. Methods and analysis: ) were recommended for standard National Health Service (NHS) prostate cancer assessment. Results: Eight GP practices sent invitations to 2096 men. 457 men (22%) responded and 303 completed both screening tests. Older white men were most likely to respond to the invitation, with black men having 20% of the acceptance rate of white men.One in six men (48/303 men, 16%) had a positive screening MRI, and an additional 1 in 20 men (16/303, 5%) had a raised PSA density alone. After NHS assessment, 29 men (9.6%) were diagnosed with clinically significant cancer and 3 men (1%) with clinically insignificant cancer.Two in three men with a positive MRI, and more than half of men with clinically significant disease had a PSA <3 ng/mL. Conclusions: Prostate MRI may have value in screening independently of PSA. These data will allow modelling of the use of MRI as a primary screening tool to inform larger prostate cancer screening studies. Trial registration number: NCT04063566.