Study shows potential of MRI-led prostate cancer screening strategy

Results of a UK study published in BMJ Oncology, show the value of prostate MRI as a screening tool both alongside and potentially independent of PSA testing.^1,2

"Our results give an early indication that MRI could offer a more reliable method of detecting potentially serious cancers early, with the added benefit that less than one per cent of participants were ‘over-diagnosed’ with low-risk disease. More studies in larger groups are needed to assess this further,” said Professor Caroline Moore.

The REIMAGINE study included 303 men who received both MRI and PSA prostate cancer screening at a London university hospital. Overall, 64 of these men had a positive screening and were recommended to receive the UK’s National Health Service (NHS) prostate cancer assessment, outside of the study. This included 48 patients with a positive MRI screening and 16 patients who had a negative MRI but a positive PSA.¹

After the NHS assessment outside of the study, 29 men had clinically significant disease, representing 9.6% of the overall population of 303 men.

Importantly, 67% (32/48) of the men with a positive MRI and over half (15/25) of the men with both a positive MRI and clinically significant disease had a PSA less than 3 ng/mL. In the UK, the benchmark level for further testing when an individual receives an initial PSA assessment is 3 ng/mL; thus, based on PSA alone, these patients would not have received any additional evaluation to look for prostate cancer.¹

“The thought that over half the men with clinically significant cancer had a PSA less than 3 ng/ml and would have been reassured that they didn’t have cancer by a PSA test alone is a sobering one and reiterates the need to consider a new approach to prostate cancer screening. Our results give an early indication that MRI could offer a more reliable method of detecting potentially serious cancers early, with the added benefit that less than one per cent of participants were ‘over-diagnosed’ with low-risk disease. More studies in larger groups are needed to assess this further,” Professor Caroline Moore, UCL Surgical & Interventional Science and consultant surgeon at UCLH, chief investigator of the study and NIHR research professor, stated in a press release.²

The 303 evaluated patients were identified and selected by invitation from 8 participating general practice (GP) practices and all were screened at one London university hospital. The mean age of these men was 61.9 years (range, 50-77), 13% of patients had a family history of prostate cancer, and 26% of patients had a Charlson Commorbidities index score ≥3. The median PSA level at baseline was 1.2 ng/mL (IQR, 0.7-2.2).¹

The researchers reported that among men invited to participate in the study, the most likely respondents tended to be older white men. The acceptance rate among black men receiving invitations was 20% of the rate of white men.

“One in four black men will get prostate cancer during their lifetime, which is double the number of men from other ethnicities. Given this elevated risk, and the fact that black men were five times less likely to sign up for the REIMAGINE trial than white men, it will be crucial that any national screening program includes strategies to reach black men and encourage more of them to come forward for testing,” Saran Green, an author of the study from King’s College London, stated in a press release.²

There are several next steps designed to build on the results of the REIMAGINE trial, including the LIMIT trial (Luminal Index MRI Identification of Prostate Cancer). This feasibility study is evaluating a novel 5-minute MRI technique for prostate cancer detection that aims to improve upon the current 35/40–minute MRI process. The study has a recruitment goal of 800 men and is intended to support a larger national trial that will facilitate the implementation of a new national prostate cancer screening program in the United Kingdom. The investigators hope that the shorter MRI technique and community-based approach of the LIMIT trial will also facilitate the expansion of screening services to all Black, Asian and Minority Ethnic (BAME) groups.²

“The UK prostate cancer mortality rate is twice as high as in countries like the US or Spain because our levels of testing are much lower than other countries. Given how treatable prostate cancer is when caught early, I’m confident that a national screening program will reduce the UK’s prostate cancer mortality rate significantly. There is a lot of work to be done to get us to that point, but I believe this will be possible within the next five to ten years,” Professor Mark Emberton (UCL Surgical & Interventional Science and consultant urologist at UCLH), senior author of the REIMAGINE study, stated in a press release.²

References

1. Moore CM, Frangou E, McCartan N on behalf of the Re-Imagine Study group, et al. Prevalence of MRI lesions in men responding to a GP-led invitation for a prostate health check: a prospective cohort study. BMJ Oncology 2023;2:e000057. doi: 10.1136/bmjonc-2023-000057

2. MRI scans improve prostate cancer diagnosis in screening trial. Accessed August 28, 2023. https://www.ucl.ac.uk/news/2023/aug/mri-scans-improve-prostate-cancer-diagnosis-screening-trial-0