Prostate cancer is a common type of tumor pathology in men, but it can be successfully treated especially when the diagnosis is established in the early stages, routine screening being necessary. The most commonly used methods of diagnosis and screening include blood tests by measuring PSA levels, clinical examination by rectal examination and the use of imaging techniques such as magnetic resonance imaging (MRI) and biopsy if changes are found in the prostate and values PSA abnormalities. PSA is a specific prostate antigen, being useful in the detection of prostate cancer in its early stages, but there are many non-tumor pathologies that can cause its increase, such as: benign prostatic hyperplasia, inflammation or infection, and differential diagnosis is necessary.
The results of a study conducted at University College London and King’s College London showed that the use of MRI scans in the screening of patients with prostate cancer can detect tumors even if PSA values are low. More than half of men with biopsy-proven, clinically significant cancer would not have been referred for further evaluation if only the PSA value had been considered.
Although previous studies have shown that using PSA levels or rectal swabs as screening methods to select men who can benefit from biopsy could reduce cancer mortality by about 20% over a 16-year period, this approach has been associated with overdiagnosis and much more aggressive treatment, even if the tumor is low-risk.
The ReIMAGINE study, published in BMJ Oncology is a prospective study, being the first analysis using MRI scans together with PSA density to select patients who need further analysis. 303 men between the ages of 50 and 75 without a history of cancer diagnosis were selected.
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The results were as follows:
• 1 in 6 men (48/303 men or 16%) had a positive MRI result
• 1 in 20 men (16/303 or 5%) only had PSA levels rise
• 2 out of 3 men with a positive MRI and over half of men with clinically significant disease had a PSA below 3 ng/ml
Magnetic resonance imaging is not currently used as a first screening modality, but its introduction before biopsy following the detection of an elevated PSA or after an abnormal rectal exam has increased the detection of clinically significant cancers (Gleason score 4 or more), reducing the number of unnecessary biopsies in high-risk men by 25%.
MRI of the pelvis can be considered in the future as a screening method independent of the PSA value, becoming the first modality in detecting prostate cancer in patients at risk, but more thorough studies are needed.
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2023-10-07 12:03:01
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