TOPLINE:
Upon examining duplicated prostate cancer screenings, scientists observed the lack of suspicious MRI findings in over 86% of guys who had prostate-specific antigen (PSA) levels of 3 ng/mL or greater throughout their 2nd screening.
APPROACH:
- New efforts are concentrating on arranging prostate cancer screening utilizing MRI to decrease overdiagnosis, as existing proof does not support the efficiency of a single PSA test, with standards now suggesting duplicated screening every 1-4 years.
- In the STHLM3-MRI trial, males, aged 50-74 years, residing in Stockholm County, Sweden, were welcomed to take part in prostate cancer screening and arbitrarily appointed to standard screening with organized prostate biopsy or an MRI-based technique.
- Blood samples were evaluated for PSA levels and Stockholm3 danger rating; guys with raised threat went through targeted MRI and biopsy treatments.
- In this follow-up analysis, 2078 guys with PSA levels of 1.5 ng/mL or greater and a Stockholm3 danger score less than 0.11 were reinvited for evaluating 2-3 years after their preliminary screening.
- The main result was medically considerable prostate cancer (Gleason rating of 3 + 4 or higher). A Gleason rating of 6 was found in 0.7% of clients, and a rating of 4 + 3 or higher was found in 19 (1.3%) males.
TAKEAWAY:
- Of 1500 males (mean age of 67 years) who went through a blood test, the average PSA level was 2.8 ng/mL and 26.0% altered danger category groups (PSA levels < < 3 vs 3 ng/mL).
- Out of 667 guys with PSA levels of 3 ng/mL or greater, 617 (92.5%) had an MRI. Of the 617, 51 (7.6%) had equivocal sores (a Prostate Imaging-Reporting and Data System rating of 3) and 33 (4.9%) had suspicious sores.
- Of the 1500 rescreened guys, scientifically considerable prostate cancer was identified in 48 males (3.2%); this represents 59.2% of the biopsied guys.
- Out of 383 guys who had actually formerly gotten an unfavorable MRI outcome, just 10 (2.6%) displayed a sore with a Prostate Imaging-Reporting and Data System rating of 4 or greater.
IN PRACTICE:
In an accompanying editorial, Ola Bratt, MD, PhD, kept in mind that the “crucial finding was the really high percentage of nonsuspicious repeat MRI scans,” however likewise highlighted the need of observing a reduction in total prostate cancer occurrence before asserting that the present cancer diagnostics efficiently minimize overdiagnosis.
SOURCE:
This research study, led by Tobias Nordström, MD, PhD, from Karolinska Institute, Stockholm, Sweden, was released on February 7, 2024, in JAMA Network Open
RESTRICTIONS:
Long-lasting results like prostate cancer death were not assessed. Info on cancer detection in males with an unfavorable MRI outcome at rescreening was not offered. Authors kept in mind that a subset of people might still be at threat regardless of lower PSA levels.
DISCLOSURES:
This research study was moneyed by the Swedish Research Council for Health, Working Life and Welfare, Karolinska Institute, Prostatacancerförbundet, Region Stockholm, and Åke Wibergs Stiftelse.