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Prostate cancer screening—stepping forward with MRI

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Abstract

Objective

To comprehensively review the literature on the integration of MRI as a diagnostic tool in prostate cancer screening and offer practical recommendations for optimising its use.

Methods

Existing research studies, clinical guidelines and expert opinions were reviewed to support the optimisation standards for MRI use in screening. Consolidated screening principles were used to make appropriate recommendations regarding the integration of MRI into the diagnostic pathway.

Results

To strike a balance between the potential benefits of early detection on mortality and minimising the harm of over-diagnosing indolent cancers, it is necessary to have a clear understanding of the context of MRI use. The key to optimisation is patient selections and MRI-targeted biopsies. For men at higher-than-average risk, it is essential to use screening-specific MRI protocols and establish accuracy levels and interpretation criteria. Optimisation of readings by the automation of data acquisition, image quality monitoring, post-processing, radiologist certification and deep-learning computer-aided software is needed. The optimal utilisation of MRI involves its integration into a multistep diagnostic pathway, supported by a quality-assured and cost-effective infrastructure that ensures community-wide access to imaging.

Conclusion

MRI in the prostate cancer screening pathway can bring substantial diagnostic benefits. By carefully considering its advantages, limitations and safety concerns and integrating it into a multistep diagnostic pathway, clinicians can improve outcomes while minimising harm to screening participants.

Clinical relevance statement

The manuscript discusses the role of MRI in prostate cancer screening, highlighting its potential to improve accuracy and reduce overdiagnosis. It emphasises the importance of optimising protocols and integrating MRI into a multistep diagnostic pathway for successfully delivering screening benefits.

Key Points

• Population screening for prostate cancer is a new indication for prostate MRI that allows the detection of high-risk cancers while reducing the need for biopsies and associated harm.

• To optimise prostate cancer screening using MRI, it is essential to redefine MRI protocols; establish accuracy levels, reliability and interpretation criteria; and optimise reading (including post-processing, image quality, radiologist certification, and deep-learning computer-aided software).

• The optimal utilisation of MRI for prostate cancer screening would involve its integration into a multistep diagnostic pathway, supported by a quality-assured and cost-effective infrastructure that ensures community-wide access to imaging.

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK

    Anwar R. Padhani

  2. Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands

    Ivo G. Schoots

  3. Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    Ivo G. Schoots

Authors
  1. Anwar R. Padhani
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Correspondence to Anwar R. Padhani.

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The scientific guarantor of this publication is Prof. Anwar R Padhani.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Padhani, A.R., Schoots, I.G. Prostate cancer screening—stepping forward with MRI. Eur Radiol 33, 6670–6676 (2023). https://doi.org/10.1007/s00330-023-09673-2

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  • DOI: https://doi.org/10.1007/s00330-023-09673-2

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