MRI screening and designated biopsies could diminish overdiagnoses of prostate malignant growth

MRI screening and designated biopsies could diminish overdiagnoses of prostate malignant growth


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  • Source: Karolinska Institutet

  • Date: 10 Jul,2021

Many countries do not have nationwide prostate-cancer screening. Current methods lead to overdiagnoses, unnecessary biopsies, and unnecessary biopsies. Researchers at Karolinska Institutet, Sweden, have published a new study in The New England Journal of Medicine. It shows that targeted biopsies and magnetic resonance imaging (MRI), could reduce overdiagnoses by up to half. These results were presented today at The European Association of Urology Congress.

“Our large randomised study shows that modern methods of prostate cancer screening have the potential to preserve the benefits and decrease the risks. This eliminates the biggest barrier to nationwide screening,” says Tobias Nordstrom (associate professor of Urology, Danderyd Hospital, Karolinska Institutet), who is responsible for the STHLM3MRI research.

Annually, around 1,4 million men are diagnosed with prostate cancer. 375,000 men also die from the disease. Studies in the past have shown that organized screening can lead to earlier detection, and reduce the chance of dying from prostate cancer.

We will soon present the second of the two main reports from the STHLM3MRI trial where we assess the role of a novel blood test as adjunct to MRI in prostate cancer screening. The future of prostate cancer diagnostics probably includes both improved blood tests and MRI. Nationwide screening for breast and cervical cancer among women has been available in the Western world for some time. We are finally able to show that men can also reduce their risk of malignant cancer through nationwide prostate-cancer screening that utilises modern methods.”

Tobias Nordström, Associate Professor of Urology, Department of Clinical Sciences, Danderyd Hospital at Karolinska Institutet

The current screening methods, which combine traditional biopsies with PSA (prostate specific antigen), result in unnecessary biopsies and the detection of many minor low-risk tumors. Lithuania is the only country that has not decided to implement a national prostate-cancer screening program. The benefits are far greater than the drawbacks.

Martin Eklund is associate professor at Karolinska Institutet’s Department of Medical Epidemiology and Biostatistics. He also has joint responsibility for the STHLM3MRI research.

STHLM3MRI results show that overdiagnoses can easily be reduced by replacing traditional prostate biopsies (MRI) with targeted biopsies and magnetic resonance imaging (MRI). This new method is able to detect as many clinically important tumours as the old one, and reduce unnecessary biopsies.

STHLM3MRI was a randomised study that was conducted in 2018-2021 with 12750 participants from Stockholm County. Participants provided blood samples for PSA analysis and analysis using the Stockholm3 test developed by Karolinska Institutet researchers. The men whose blood tests revealed elevated levels were randomly chosen for either traditional biopsies (MRI) or a conventional biopsy. Biopsies in the MRI group were limited to suspected tumours that had been identified by MRI.

The next step was to investigate how the Stockholm3 test and MRI could be combined to improve the screening method for prostate cancer.

Professor Hendrik van Poppel, Adjunct Secretary General of the European Association of Urology said that it was exciting to see such breakthroughs in the field of early detection of prostate carcinoma. STHLM3MRI is a compelling argument for the European Commission to adopt a risk stratified approach in early detection of prostate carcinoma across Europe. EAU is working hard for early detection of prostate carcinoma to be addressed in Europe’s Beating Cancer Plan. This plan will reduce the mortality rate of Europe’s most deadly male cancers while simultaneously addressing the issues of overdiagnosis, overtreatment and overdiagnosis. We look forward to seeing what STHLM3MRI can do to further this goal.

Journal reference:

Eklund, M., et al. (2021) MRI-Targeted or Standard Biopsy in Prostate Cancer Screening. New England Journal of Medicine.

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