Combining Magnetic Resonance Imaging (MRI) with conventional screening may greatly improve prostate cancer detection and help avoid unnecessary biopsies, show initial results from the Goteborg randomised screening trial. The trial is a Swedish version of the European Randomized Study of Screening for Prostate Cancer, which is considered to be the largest randomized prostate cancer screening trial.
In 2014, results from this trial found a significant mortality reduction with prostate-specific antigen (PSA) screening for men aged 55-69 years of age. Now, a new study presented at the European Association of Urology (EAU) Conference in Madrid (going on till 24 March 2015) shows that using MRI may further improve the accuracy of prostate
experiment has been awarded the EAU's First Prize for the Best Abstract by a Resident.
Prostate cancer is the second most common
cancer in men after lung cancer and second leading cause of cancer death in men
in Western Europe. More than 670,000 men are diagnosed with prostate cancer
cases, screening for prostate cancer using Prostate-specific antigen (PSA) tends to give false negatives and false
positives. Hence, many men are subject to invasive testing and perhaps
treatment, which was just not necessary.
Hugosson and his Swedish research team chose 384 patients attending the
Goteborg trial, and asked 124 of them to go for an MRI prior to having a
biopsy. Those with a suspicious MRI, or with a PSA >
3 ng/ml, were
recommended for biopsy. Tissue samples taken at random from the prostate are
called standard samples and samples from the suspicious areas seen on the MRI
are targeted samples. Scientists took standard and targeted samples.
experiment found that the combining PSA and MRI gave better prostate cancer
. The results also showed
that even potentially aggressive cancers were detected with PSA, MRI
combination screening compared with using PSA stand-alone test in screening.
research team said that the combination might point to a strategy to maximize
success in prostate cancer screening.
these initial results, it looks like we can combine PSA levels with
MRI scans to give more accurate screening results. This strategy would allow us
to take men with lower PSA scores, and give them MRI scans, to confirm whether
or not a biopsy is absolutely necessary," said Dr.Anna Grenabo-Bergdahl, Sahlgrenska University Hospital, Goteborg, Sweden. "Another benefit is that the MRI
helps us locate the suspect area, meaning that if we have to do a confirmatory
biopsy, we have a much better idea of where the problem might be. This avoids
patient stress, and means we are less likely to miss cancers."
The Swedish researcher was visibly upbeat about the results from the
pilot study but she said she need confirmation. "We are starting a trial of 40,000 patients in
the Goteborg area. If we can replicate the results
from our pilot study this may lead to a paradigm shift in future screening and
fundamentally change the way we handle early detection of prostate cancer," she
Prof.Manfred Wirth, EAU Treasurer, concurred, and said, "We definitely need a bigger research to validate
these results. There are some real issues to address. For example, MRI is
currently not cost-effective to use in routine screening and we cannot consider
routine screening as well."