ProstaPilot: A Comparative Study of Biparametric Magnetic Resonance Imaging Versus Prostate-specific Antigen as a Screening Test for Prostate Cancer

Abstract

Background and objective

Our aim was to compare detection rates for clinically significant prostate cancer (csPC) between biparametric magnetic resonance imaging (bpMRI) and prostate-specific antigen (PSA) screening pathways in the Czech population, which has a high prevalence of opportunistic PSA testing (45% in the target age group).

Methods

Between May 2022 and May 2023, 423 men aged 50–69 yr who were enrolled via volunteer-based recruitment, underwent both PSA testing and bpMRI of the prostate. Positive results were defined as PSA ≥3 μg/l or a Prostate Imaging-Reporting and Data System score of 4-5. Those with positive tests were referred for further evaluation, including an MRI-targeted biopsy and a systematic 12-core biopsy. csPC was defined as any cancer of International Society of Urological Pathology grade group ≥2.

Key findings and limitations

Of the 423 men, 35 (8.3%) had at least one positive screening test. The PSA-based pathway identified 25 men (5.9%), whereas the MRI-based pathway identified 16 (3.8%) with suspicion of PC, with potential to reduce the number of biopsies required by 36%. Subsequent biopsy revealed PC in seven men (1.7%) with a positive PSA test and 14 men (3.3%) with positive MRI findings. Nonsignificant PC and csPC rates were 1.0% (n = 4) and 0.7% (n = 3) for the PSA pathway, and 1.7% and 1.7% (n = 7) for the MRI pathway, respectively.

Conclusions and clinical implications

In a highly prescreened population, bpMRI may increase the csPC detection rate while reducing the number of biopsies needed in comparison to PSA-based diagnosis. However, bpMRI may also slightly increase the detection of grade group 1 cancers.

Patient summary

We compared a blood test for PSA (prostate-specific antigen) and an MRI scan (magnetic resonance imaging) for detection of prostate cancer in men aged 50–69 years. We found that MRI scans may reduce the number of biopsies that need to be performed for cancer diagnosis while increasing the detection rate for cancers that are significant.