PSA Testing Versus MRI or Ultrasonography in Detecting Clinically Significant Prostate Cancer
Posted: Wednesday, May 12, 2021
Prostate-specific antigen (PSA) testing may lead to under- or overdiagnosis of prostate cancer. Hashim U. Ahmed, BM, BCh, of the Imperial College London, United Kingdom, and colleagues conducted a study to compare the performance of PSA testing, MRI, and ultrasonography as cancer screening tests. The findings of the multicenter IP1-PROSTAGRAM study were published in JAMA Oncology.
“When screening the general population for prostate cancer, MRI using a score of 4 or 5 to define a positive test result, compared with PSA alone at 3 ng/mL or higher, was associated with more men diagnosed with clinically significant cancer,” the investigators commented.
A total of 408 men underwent a PSA test, noncontrast MRI, and transrectal ultrasonography. A PSA level of 3 ng/mL was the cutoff for positive results; a score of 3 to 5 or 4 to 5 indicated positive MRI and ultrasonography results. At an imaging threshold of a score of 3 to 5, more men had positive results with MRI or ultrasonography than with PSA testing (P < .001 for both). The proportions of patients with positive results appeared similar to PSA and MRI screening at an imaging threshold of score 4 to 5 (P = .71); this finding also seemed to hold true with ultrasonography (P = .15).
The PSA test detected seven cases of clinically significant cancer. An MRI score of 3 to 5 detected 14 cases, and a score of 4 to 5 detected 11 cases; an ultrasonography score of 3 to 5 detected 9 cases, and a score of 4 to 5 detected 4 cases.
A total of six cases of clinically insignificant cancer were detected by PSA testing. An MRI score of 3 to 5 detected 7 cases, and a score of 4 to 5 detected 5 cases; an ultrasonography score of 3 to 5 detected 13 cases, and a score of 4 to 5 detected 7 cases.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
