MRI-Based Screening May Detect Prostate Cancer Earlier

A study presented at the American Urological Association annual meeting evaluated an intensified MRI-based screening program for men at high genetic risk for prostate cancer.

In this exclusive MedPage Today video, Keyan Salari, MD, PhD, director of the Prostate Cancer Genetics Program at Massachusetts General Hospital in Boston, discusses the design and results from the Prostate Cancer Genetic Risk Evaluation and Screening Study (PROGRESS).

Following is a transcript of his remarks:

The work that we were presenting today relates to screening for prostate cancer among high-risk men who have germline pathogenic mutations in prostate cancer risk genes. Now that genetic testing is being done more and more commonly, with expanding indications for doing germline genetic testing, we’re identifying more and more men who have these pathogenic mutations. And there’s been open questions still about how to best screen for such men who have heightened risks of prostate cancer.

And so what we did in our study, is a prospective study evaluating MRI-based screening strategies for these men who have high-risk mutations as a way to enhance early detection. So we took men who are ages between 35 and 75 and have a pathogenic or likely pathogenic mutation in one of 19 different prostate cancer risk genes.

There’s different evidence for these different genes. Some of them, like BRCA2, have the strongest evidence that we’re fairly confident that it increases the risk of prostate cancer, particularly aggressive forms of prostate cancer. And then there are other genes that have less evidence behind them. We’re trying to learn more about what the natural history of men who have these mutations is.

So we’ve enrolled just under 100 patients. And we are sharing results at the conference today about essentially 89 patients who have completed the first round of screening with MRI and then prostate exams and PSA [prostate-specific antigen] tests. So we’ve been offering patients, that’s how we’re doing their screening with an annual PSA and prostate exam, and then a baseline MRI every 3 years.

Anyone who has an abnormal MRI, defined as a PI-RADS [Prostate Imaging Reporting and Data Score] ≥3, or an abnormal prostate exam or PSA, we’ve offered a prostate biopsy too. And 14 patients out of the 89 so far have had a prostate biopsy, and we’ve diagnosed eight cases of prostate cancer. Three quarters of those were clinically significant cancers.

And the notable thing is that the majority of these cancers were picked up only on the basis of the MRI — so meaning the PSA was normal, the prostate exam was normal; the MRI is really what drew our attention to identify these cancers.

So our early results suggested that prostate MRI may enhance our ability to detect these cases early, and I think they’ll be important to be incorporating risk-adapted screening strategies moving forward. Again, as we learn more about these patients and we identify more patients who have these types of mutations, trying to move away from a one-size-fits-all screening approach, but to more of a risk-adapted screening approach, I think is going to be important.