Clinical and economic impact of the introduction of pre-biopsy MRI-based assessment on a large prostate cancer centre diagnostic population and activity: 10 years on

The Utility of Contemporary Community-Based Prostate Cancer Screening Campaigns

INTRODUCTION

While early detection of prostate cancer (PCa) might provide benefits in terms of PCa mortality, this might be associated with overdiagnosis and overtreatment of indolent cancers. We aimed to evaluate our community-based PCa early-detection campaigns.

METHODS

A retrospective review of 19 PCa early-detection campaigns led by our institution was conducted between 2015 and 2023. These campaigns included PSA testing and digital rectal examinations (DRE) for all comers, followed by elective workup of at-risk patients, with follow-up PSA testing and multiparametric MRI (mpMRI). Data were reviewed for demographics and clinical parameters. Descriptive statistics were used to describe the data. Logistic regression was used to identify the factors associated with diagnosis of PCa.

RESULTS

1171 men were included with median PSA of 1.1 ng/ml (IQR 0.6-2.5). Eighty seven men (7.4%) underwent prostate biopsy. Of those, 66 (76%) were diagnosed with prostate cancer (14% with Gleason grade group (GG) 1 and 86% with GG2 or higher-clinically significant prostate cancer (csPCa). Higher PSA (OR 1.62, 95% CI 1.42-1.85, P < .0001) and suspicious DRE (OR 97, 95% CI 38-248, P < .0001) were associated with diagnosis of csPCa. The number needed to screen to diagnose 1 case of PCa was 18 (95% CI 14-22) and the number needed to screen to diagnose 1 case of csPCa was 21 (95% CI 16-27).

CONCLUSION

Herein we describe our experience with contemporary PCa screening campaigns combining traditional screening with PSA and DRE with prostate MRI and judicious use of prostate biopsy.