. 2023 Aug 21;2(1):e000057.

doi: 10.1136/bmjonc-2023-000057. eCollection 2023.

Prevalence of MRI lesions in men responding to a GP-led invitation for a prostate health check: a prospective cohort study

Caroline M Moore^{1

2}, Elena Frangou³, Neil McCartan^{1

4}, Aida Santaolalla⁵, Douglas Kopcke^{6

7}, Giorgio Brembilla⁶, Joanna Hadley^{2

6}, Francesco Giganti^{1

7}, Teresa Marsden^{1

2}, Mieke Van Hemelrijck⁵, Fiona Gong⁶, Alex Freeman⁸, Aiman Haider⁸, Steve Tuck⁹, Nora Pashayan¹⁰, Thomas Callender¹¹, Saran Green⁵, Louise C Brown³, Shonit Punwani^{6

7}, Mark Emberton^{2

12}

Affiliations

¹ Division of Surgery & Interventional Science, University College London, London, UK.
² Urology, University College London Hospitals NHS Foundation Trust, London, UK.
³ MRC Clinical Trials Unit, University College London, London, UK.
⁴ Our Future Health, London, UK.
⁵ Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society and Public Health, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
⁶ Centre for Medical Imaging, University College London, London, UK.
⁷ Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK.
⁸ Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK.
⁹ Oxfordshire Prostate Cancer Support Group, Oxford, UK.
¹⁰ Department of Applied Health Research, University College London, London, UK.
¹¹ Division of Medicine, University College London, London, UK.
¹² Faculty of Medical Sciences, University College London, London, UK.

PMID: 39886504
PMCID: PMC11315271
DOI: 10.1136/bmjonc-2023-000057

Prevalence of MRI lesions in men responding to a GP-led invitation for a prostate health check: a prospective cohort study

Caroline M Moore et al. BMJ Oncol. 2023.

. 2023 Aug 21;2(1):e000057.

doi: 10.1136/bmjonc-2023-000057. eCollection 2023.

Authors

Affiliations

¹ Division of Surgery & Interventional Science, University College London, London, UK.
² Urology, University College London Hospitals NHS Foundation Trust, London, UK.
³ MRC Clinical Trials Unit, University College London, London, UK.
⁴ Our Future Health, London, UK.
⁵ Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society and Public Health, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
⁶ Centre for Medical Imaging, University College London, London, UK.
⁷ Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK.
⁸ Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK.
⁹ Oxfordshire Prostate Cancer Support Group, Oxford, UK.
¹⁰ Department of Applied Health Research, University College London, London, UK.
¹¹ Division of Medicine, University College London, London, UK.
¹² Faculty of Medical Sciences, University College London, London, UK.

PMID: 39886504
PMCID: PMC11315271
DOI: 10.1136/bmjonc-2023-000057

Abstract

Objective: In men with a raised prostate-specific antigen (PSA), MRI increases the detection of clinically significant cancer and reduces overdiagnosis, with fewer biopsies. MRI as a screening tool has not been assessed independently of PSA in a formal screening study. We report a systematic community-based assessment of the prevalence of prostate MRI lesions in an age-selected population.

Methods and analysis: Men aged 50-75 were identified from participating general practice (GP) practices and randomly selected for invitation to a screening MRI and PSA. Men with a positive MRI or a raised PSA density (≥0.12 ng/mL²) were recommended for standard National Health Service (NHS) prostate cancer assessment.

Results: Eight GP practices sent invitations to 2096 men. 457 men (22%) responded and 303 completed both screening tests. Older white men were most likely to respond to the invitation, with black men having 20% of the acceptance rate of white men.One in six men (48/303 men, 16%) had a positive screening MRI, and an additional 1 in 20 men (16/303, 5%) had a raised PSA density alone. After NHS assessment, 29 men (9.6%) were diagnosed with clinically significant cancer and 3 men (1%) with clinically insignificant cancer.Two in three men with a positive MRI, and more than half of men with clinically significant disease had a PSA <3 ng/mL.

Conclusions: Prostate MRI may have value in screening independently of PSA. These data will allow modelling of the use of MRI as a primary screening tool to inform larger prostate cancer screening studies.

Trial registration number: NCT04063566.

Keywords: Cancer screening; Prostate cancer.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare support from the MRC and CRUK as above for the submitted work, and no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work.Declaration of other interests. ME receives research support from the United Kingdom’s National Institute of Health Research (NIHR) UCLH / UCL Biomedical Research Centre. He has no direct conflict of interest associated with the work presented in this paper. He acts as an advisor/consultant to SonaCare Inc; Nina Medical; Exact Imaging and Angiodynamics Inc. CM is funded via an NIHR Research Professorship. She has received clinical trial funding from SpectraCure, proctor fees for HIFU proctoring from SonaCare and speaker fees from Ipsen in the last three years. She carries out research into photodynamic therapy supported by Spectracure. FG is a recipient of the 2020 Young Investigator Award (20YOUN15) funded by the Prostate Cancer Foundation / CRIS Cancer Foundation. FG reports consulting fees from Lucida Medical LTD outside of the submitted work.

Figures

**Figure 1**
Study participant flowchart. PSA, prostate-specific antigen.

**Figure 2**
Histogram of PSA distribution according to MRI result. PSA, prostate-specific antigen.

See this image and copyright information in PMC

References

1. Available: https://www.cancerresearchuk.org/health-professional/cancer-statistics/s...
1. Ferlay J, Ervik M, Lam F, et al. . Global cancer Observatory: cancer today. Lyon, France: International Agency for Research on Cancer; 2020. Available: https://gco.iarc.fr/today
1. Hugosson J, Roobol MJ, Månsson M, et al. . A 16-yr follow-up of the European randomized study of screening for prostate cancer. Eur Urol 2019;76:43–51. 10.1016/j.eururo.2019.02.009 - DOI - PMC - PubMed
1. Martin RM, Donovan JL, Turner EL, et al. . Effect of a low-intensity PSA-based screening intervention on prostate cancer mortality: the CAP randomized clinical trial. JAMA 2018;319:883–95. 10.1001/jama.2018.0154 - DOI - PMC - PubMed
1. Kasivisvanathan V, Emberton M, Moore CM. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 2018;379:589–90. 10.1056/NEJMc1807507 - DOI - PubMed

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Prevalence of MRI lesions in men responding to a GP-led invitation for a prostate health check: a prospective cohort study

Affiliations

Prevalence of MRI lesions in men responding to a GP-led invitation for a prostate health check: a prospective cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Associated data

LinkOut - more resources

Full Text Sources

Research Materials