Journal Article (Review Article)

DKFZ-2025-01228

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Magnetic Resonance Imaging-based Biopsy Strategies in Prostate Cancer Screening: A Systematic Review.

Schoots, I. G. ; Ahmed, H. U. ; Albers, P.DKFZ* ; Asbach, P. ; van den Bergh, R. C. N. ; Godtman, R. A. ; van Leeuwen, P. J. ; Nordström, T. ; Punwani, S. ; Wallström, J. ; Padhani, A. R.

2025
Elsevier Science Amsterdam [u.a.]

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Please use a persistent id in citations: doi:10.1016/j.eururo.2025.05.038

Abstract: Prostate cancer (PCa) screening using prostate-specific antigen (PSA) thresholding and systematic biopsies reduces advanced disease presentations and cancer-specific mortality, but also leads to overdiagnosis. Magnetic resonance imaging (MRI) integration may maintain screening benefits, while reducing overdiagnosis and unnecessary biopsies. This review analyses the benefit-harm balance when MRI is integrated as first-line and second-stage (after PSA >3 ng/ml) test in PCa screening.Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed a PROSPERO-registered systematic review (CRD420251006926). Literature searches identified five first-line and four second-stage MRI screening studies. We assessed MRI strategies (first-line/second-stage and risk thresholds), biopsy avoidance, and biopsy methods (targeted/systematic) for histological outcomes (grade group [GG] ≥2/GG 1 cancer detection and benign biopsies). Benefit-to-harm ratios of >1 suggest a positive net benefit.First-line MRI screening detects twice as many men with GG ≥2 cancer as second-stage MRI screening but has more MRI-negative men (range, 66-89% vs 56-61%). Second-stage MRI significantly reduced biopsy rates (range, 42-79%) compared with systematic biopsy rates in all PSA-positive men. Subsequently, GG ≥2/GG 1 cancer detection ratios increased in MRI-positive men undergoing targeted and systematic biopsies (range, 1.9-6.2) and targeted biopsies alone (range, 1.8-7.0), compared with systematic biopsies alone (range, 0.8-1.4). First-line and second-stage MRI screening allowed biopsy avoidance in three to 125 and two to 15 men, respectively, for each benign diagnosis. All benefit-to-harm ratios showed positive net benefits (>1). Heterogeneity in the study protocols limits generalisability.Targeted biopsies in second-stage MRI screening optimise clinically significant PCa detection, while reducing the number of biopsies. First-line MRI screening requires further assessments of its feasibility. PCa screening quality assurance requires standardised MRI interpretations and biopsy protocols.

Keyword(s): Diagnosis ; Image-guided biopsy ; Magnetic resonance imaging ; Prostatic neoplasms ; Screening

Note: 2025 Sep;88(3):247-260

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Contributing Institute(s):

1. Personalisierte Früherkennung des Prostatakarzinoms (C130)

Research Program(s):

1. 313 - Krebsrisikofaktoren und Prävention (POF4-313) (POF4-313)

Appears in the scientific report 2025

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Database coverage:
; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; Ebsco Academic Search ; Essential Science Indicators ; IF >= 20 ; JCR ; National-Konsortium ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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