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@ARTICLE{Schoots:302037,
      author       = {I. G. Schoots and H. U. Ahmed and P. Albers$^*$ and P.
                      Asbach and R. C. N. van den Bergh and R. A. Godtman and P.
                      J. van Leeuwen and T. Nordström and S. Punwani and J.
                      Wallström and A. R. Padhani},
      title        = {{M}agnetic {R}esonance {I}maging-based {B}iopsy
                      {S}trategies in {P}rostate {C}ancer {S}creening: {A}
                      {S}ystematic {R}eview.},
      journal      = {European urology},
      volume       = {88},
      number       = {3},
      issn         = {0302-2838},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {DKFZ-2025-01228},
      pages        = {247-260},
      year         = {2025},
      note         = {2025 Sep;88(3):247-260},
      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.},
      subtyp        = {Review Article},
      keywords     = {Diagnosis (Other) / Image-guided biopsy (Other) / Magnetic
                      resonance imaging (Other) / Prostatic neoplasms (Other) /
                      Screening (Other)},
      cin          = {C130},
      ddc          = {610},
      cid          = {I:(DE-He78)C130-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40514255},
      doi          = {10.1016/j.eururo.2025.05.038},
      url          = {https://inrepo02.dkfz.de/record/302037},
}