Prevalence of MRI lesions in men responding to a GP-led invitation for a prostate health check: a prospective cohort study

  • Moore C
  • Frangou E
  • McCartan N
  • et al.
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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 Men aged 50–75 were identified from participating general practice (GP) practices and randomly selected for invitation to a screening MRI and PSA. Men with a positive MRI or a raised PSA density (≥0.12 ng/mL2) 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][1]. Data are available upon reasonable request. The datasets generated for this study can be found in the ReIMAGINE instance of the Philips HSDP CDL at. These datasets are currently accessible only to the consortium partners of the ReIMAGINE project. After completion of the project, the data will also be available to the broader clinical and scientific community via request to the ReIMAGINE Group (reimagine@ucl.ac.uk). All data released (Individual participant data (including data dictionaries)) from the consortium will appear in an anonymised format. The study protocol, statistical analysis plan, and informed consent will be available after publication. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04063566&atom=%2Fbmjonc%2F2%2F1%2Fe000057.atom

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Moore, C. M., Frangou, E., McCartan, N., Santaolalla, A., Kopcke, D., Brembilla, G., … Emberton, M. (2023). Prevalence of MRI lesions in men responding to a GP-led invitation for a prostate health check: a prospective cohort study. BMJ Oncology, 2(1), e000057. https://doi.org/10.1136/bmjonc-2023-000057

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