| 1. |
- Kohestani, Kimia
(författare)
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Magnetic Resonance Imaging as a Screening Tool for Prostate Cancer
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to explore the role of Magnetic resonance imaging (MRI) of the prostate as an adjunct to the prostate-specific antigen (PSA)-test in screening for prostate cancer (PCa), focusing on the performance of MRI in detecting clinically significant PCa within the randomised controlled GÖTEBORG Prostate Cancer Screening 2 Trial. By inviting men 50–60 years of age to different screening strategies—PSA cut-off for biopsy 3.0 ng/mL versus 1.8 ng/mL and MRI followed by systematic +/- targeted biopsies—this ongoing trial evaluates whether PSA-testing followed by MRI and targeted biopsies can reduce overdiagnosis, while maintaining the detection of clinically significant PCa, as compared to PSA and systematic biopsy. Paper I evaluates the performance of prostate MRI outside high-volume centres. A moderate PCa detection rate and large variability between readers were found, underlining the importance of continuing quality assurance initiatives where each local MRI unit records and evaluates its own detection rate, as well as robust training programs for radiologists. Paper II describes the study design and assesses the participation rates in the Göteborg-2 trial. Acceptable participation rates were found for PSA, MRI and biopsy. Paper III evaluates the value of systematic biopsies in sequential screening for PCa with PSA followed by MRI. With experienced radiologists reporting MRI, omitting systematic biopsies can be feasible in a program with repeat screening and could reduce unnecessary biopsies. Paper IV evaluates the role of pre-biopsy prostate MRI in risk stratification for men with newly diagnosed PCa and was found to be of added value. How information from MRI is best utilized in clinical practice remains to be clarified. In summary, PSA-testing and prostate MRI are cornerstones in screening and early detection of PCa. Further research in the coming years will shed light on how to customize optimal screening strategies.
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| 2. |
- Kohestani, Kimia, et al.
(författare)
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The Göteborg prostate cancer screening 2 trial: a prospective, randomised, population-based prostate cancer screening trial with prostate-specific antigen testing followed by magnetic resonance imaging of the prostate
- 2021
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Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 55:2, s. 116-124
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Tidskriftsartikel (refereegranskat)abstract
- Objective To describe the study design of the GoTEBORG prostate cancer screening (PC) 2 (Goteborg-2), a prospective, randomised, population-based trial of PC screening. This trial evaluates whether prostate-specific antigen (PSA) testing followed by 3 Tesla prostate magnetic resonance imaging (MRI) and targeted biopsy can reduce overdiagnosis, while maintaining the detection of clinically significant cancer, compared to PSA-screening and systematic biopsy. Materials and methods A random sample of men 50-60 years in the Goteborg area, Sweden, identified from the Total Population Register, were randomised to either a screening or control group (CG). Participants in the screening group (SG) were further randomised into one of three arms: (1) PSA-test; if PSA >= 3 ng/mL, then MRI and systematic biopsy, plus targeted biopsy to suspicious lesions as per Prostate Imaging - Reporting and Data System, version 2 (PI-RADSv2) 3-5; (2) PSA-test; if PSA >= 3 ng/mL, then MRI, and targeted biopsy only if PI-RADSv2 3-5; (3) identical to Arm 2, except lower PSA-cut-off >= 1.8 ng/mL. The primary outcome is the detection rate of clinically insignificant PC (defined as Gleason Score 3 + 3 [Grade Group 1]) comparing all men with PSA >= 3 ng/mL in Arm 1 vs. Arm 2 + 3. Results Randomisation and enrolment started in September 2015. Accrual has hitherto resulted in 38,770 men randomised to the SG. The participation rate is 50%. Invitation to the first screening round was completed in June 2020. Conclusions The Goteborg-2 trial will provide new knowledge about the performance of prostate MRI in a screening setting.
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| 3. |
- Wallström, Jonas, et al.
(författare)
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Bi- or multiparametric MRI in a sequential screening program for prostate cancer with PSA followed by MRI? Results from the Goteborg prostate cancer screening 2 trial
- 2021
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Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 31, s. 8692-8702
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The PIRADS Steering Committee has called for "higher quality data before making evidence-based recommendations on MRI without contrast enhancement as an initial diagnostic work up," however, recognizing biparametric (bp) MRI as a reasonable option in a low-risk setting such as screening. With bpMRI, more men can undergo MRI at a lower cost and they can be spared the invasiveness of intravenous access. The aim of this study was to assess cancer detection in bpMRI vs mpMRI in sequential screening for prostate cancer (PCa). Methods Within the ongoing Goteborg PCa screening 2 trial, we assessed cancer detection in 551 consecutive participants undergoing prostate MRI. In the same session, readers first assessed bpMRI and then mpMRI. Four targeted biopsies were performed for lesions scored PIRADS 3-5 with bpMRI and/or mpMRI. Results Cancer was detected in 84/551 cases (15.2%; 95% CI: 12.4-18.4) with mpMRI and in 83/551 cases (15.1%; 95% CI: 12.3-18.2%) with bpMRI. The relative risk (RR) for cancer detection with bpMRI compared to mpMRI was 0.99 (95% one-sided CI: > 94.8); bpMRI was non-inferior to mpMRI (10% non-inferiority margin). bpMRI resulted in fewer false positives, 45/128 (35.2%), compared to mpMRI, 52/136 (38.2%), RR = 0.92; 95% CI: 0.84-0.98. Of 8 lesions scored positive only with mpMRI, 7 were false positives. The PPV for MRI and targeted biopsy was 83/128 (64.8%) for bpMRI and 84/136 (61.8%) for mpMRI, RR = 1.05, 95% CI: 1.01-1.10. Conclusions In a PSA-screened population, bpMRI was non-inferior to mpMRI for cancer detection and resulted in fewer false positives.
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