Abstract
BACKGROUND AND OBJECTIVE: Our aim was to compare detection rates for clinically significant prostate cancer (csPC) between biparametric magnetic resonance imaging (bpMRI) and prostate-specific antigen (PSA) screening pathways in the Czech population, which has a high prevalence of opportunistic PSA testing (45% in the target age group). METHODS: Between May 2022 and May 2023, 423 men aged 50-69 yr who were enrolled via volunteer-based recruitment, underwent both PSA testing and bpMRI of the prostate. Positive results were defined as PSA ≥3 μg/l or a Prostate Imaging-Reporting and Data System score of 4-5. Those with positive tests were referred for further evaluation, including an MRI-targeted biopsy and a systematic 12-core biopsy. csPC was defined as any cancer of International Society of Urological Pathology grade group ≥2. KEY FINDINGS AND LIMITATIONS: Of the 423 men, 35 (8.3%) had at least one positive screening test. The PSA-based pathway identified 25 men (5.9%), whereas the MRI-based pathway identified 16 (3.8%) with suspicion of PC, with potential to reduce the number of biopsies required by 36%. Subsequent biopsy revealed PC in seven men (1.7%) with a positive PSA test and 14 men (3.3%) with positive MRI findings. Nonsignificant PC and csPC rates were 1.0% (n = 4) and 0.7% (n = 3) for the PSA pathway, and 1.7% and 1.7% (n = 7) for the MRI pathway, respectively. CONCLUSIONS AND CLINICAL IMPLICATIONS: In a highly prescreened population, bpMRI may increase the csPC detection rate while reducing the number of biopsies needed in comparison to PSA-based diagnosis. However, bpMRI may also slightly increase the detection of grade group 1 cancers. PATIENT SUMMARY: We compared a blood test for PSA (prostate-specific antigen) and an MRI scan (magnetic resonance imaging) for detection of prostate cancer in men aged 50-69 years. We found that MRI scans may reduce the number of biopsies that need to be performed for cancer diagnosis while increasing the detection rate for cancers that are significant.