MRI with PSA prevents unnecessary biopsies among patients of suspected prostate cancer

South Korea: A new study conducted by Moon Hyung Choi and colleagues shows that prebiopsy MRI was consistently helpful in preventing needless biopsy in individuals with prostate-specific antigen (PSA) levels of 20 ng/mL.

The findings of this study were published in the Academic Radiology journal.

It has long been common practice to assess the potential for prostate cancer using prostate-specific antigens. The effectiveness of PSA as a screening tool to find prostate cancer has not been shown, nevertheless. In order to predict prostate cancer in individuals with PSA 20 ng/mL, this study was done with the goal of evaluating the diagnostic abilities of prostate-specific antigen and PSA using prostate magnetic resonance imaging (MRI).

For this study, the PSA test and pre-biopsy MRI were used to identify patients with prostate cancer suspicion (n = 881). Prostate cancer was detected using the findings of a prostate biopsy or two years' worth of clinical data. It was determined how well the PSA, MRI, and PSA plus MRI (referred to as the protocol) performed as diagnostic tools. In patient subgroups with certain ranges of PSA levels, the positive predictive value (PPV) and negative predictive value (NPV) of the MRI were computed.

The key findings of this study were:

1. In 220 and 162 individuals, respectively, diagnoses of prostate cancer and CSC were made.

2. Compared to PSA 4 ng/mL alone, MRI might significantly increase specificity and PPV (0.833 and 0.567) for identifying CSC (0.248 and 0.0219).

3. Despite the protocol's sensitivity (0.679) being less than PSA's (0.938), it had a similar NPV to PSA (0.929 vs. 0.924).

4. The procedure consistently showed that PPV and NVP outperformed PSA only in individuals outside of the grey zone of PSA as well as in those with higher PSA.

Reference: 

Choi, M. H., Ha, U.-S., Park, Y.-H., Hong, S.-H., Lee, J. Y., Lee, Y. J., Lee, W., & Jung, S. (2022). Combined MRI and PSA Strategy Improves Biopsy Decisions Compared with PSA Only: Longitudinal Observations of a Cohort of Patients with a PSA Level Less Than 20 ng/mL. In Academic Radiology. Elsevier BV. https://doi.org/10.1016/j.acra.2022.07.020