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001     302037
005     20250831022349.0
024 7 _ |a 10.1016/j.eururo.2025.05.038
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024 7 _ |a 0302-2838
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024 7 _ |a 1421-993X
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024 7 _ |a 1873-7560
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037 _ _ |a DKFZ-2025-01228
041 _ _ |a English
082 _ _ |a 610
100 1 _ |a Schoots, Ivo G
|b 0
245 _ _ |a Magnetic Resonance Imaging-based Biopsy Strategies in Prostate Cancer Screening: A Systematic Review.
260 _ _ |a Amsterdam [u.a.]
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500 _ _ |a 2025 Sep;88(3):247-260
520 _ _ |a 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.
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650 _ 7 |a Diagnosis
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650 _ 7 |a Image-guided biopsy
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650 _ 7 |a Magnetic resonance imaging
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650 _ 7 |a Prostatic neoplasms
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650 _ 7 |a Screening
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700 1 _ |a Ahmed, Hashim U
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700 1 _ |a Albers, Peter
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700 1 _ |a Asbach, Patrick
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700 1 _ |a van den Bergh, Roderick C N
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700 1 _ |a Godtman, Rebecka A
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700 1 _ |a van Leeuwen, Pim J
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700 1 _ |a Nordström, Tobias
|b 7
700 1 _ |a Punwani, Shonit
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700 1 _ |a Wallström, Jonas
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700 1 _ |a Padhani, Anwar R
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773 _ _ |a 10.1016/j.eururo.2025.05.038
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