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Dr Margaret Shi, 13 Jul 2020

An MRI-first diagnostic pathway, combined with risk-tailored screening, is shown to improve the benefit-to-harm profile and cost-effectiveness of screening for prostate cancer (PCa), according to results of a recent lifetable modelling study presented at AACR 2020 Virtual Meeting II.

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MRI-first prostate cancer screening cost-effective with benefits

Dr Margaret Shi
13 Jul 2020

An MRI-first diagnostic pathway, combined with risk-tailored screening, is shown to improve the benefit-to-harm profile and cost-effectiveness of screening for prostate cancer (PCa), according to results of a recent lifetable modelling study presented at AACR 2020 Virtual Meeting II.

In a recent systemic review and meta-analysis, an MRI pathway (ie, multiparametric MRI ± MRI-targeted prostate biopsy) demonstrated the most favourable diagnostic accuracy for detection of clinically significant PCa among various diagnostic strategies considered. [Cochrane Database Syst Rev 2019;18:e728-e729]

Comparing between the MRI pathway vs template-guided prostate biopsy and systemic prostate biopsy vs template-guided prostate biopsy, the MRI pathway demonstrated greater test sensitivity whilst maintaining a similar level of specificity (pooled sensitivity, 0.72 vs 0.63) (pooled specificity, 0.96 vs 1.00), with a pooled detection ratio of 1.12 in a mixed population of biopsy-naïve and previously biopsy-negative men.

In the current study, projecting age-specific PCa incidence and mortality, a hypothetical cohort of 4.48 million PCa-free men (age, 55–69 years) in the UK were simulated to receive no PCa screening, age-based screening (ie, quadrennial prostate-specific antigen [PSA] testing at 55–69 years of age), or risk-tailored screening (ie, quadrennial PSA testing if the 10-year absolute risk threshold was reached based on age and polygenic profile before the age of 70 years) strategies using biopsy-first and MRI-first diagnostic pathways. [Callender T, et al, AACR 2020 Virtual Meeting II, abstract 4758; PLOS Med 2019, doi: 10.1371/journal.pmed.1002998]

Polygenic risk was calculated from known risk susceptibility loci, with the 10-year absolute risk varying between 2 percent and 10 percent.

Trade-offs of benefit and harm were compared among different screening strategies, while cost-effectiveness analysis from a health service perspective was assessed at a discounted rate of 3.5 percent per annum.

“Compared with age-based screening, an MRI-first diagnostic pathway led to a 13.8 percent and 26.0 percent reduction in the number of overdiagnosed PCa cases and unnecessary biopsies, respectively, whilst preventing 1.8 percent more deaths from PCa, leading to greater quality-adjusted life-years [QALYs] gains and a 8.4 percent lowering in screening cost,” the researchers reported. “These gains necessitated a 3.7-fold increase in the number of MRI scans performed in an age-based screening programme.”

“The risk-tailored screening strategy vs age-based screening strategy, both using an MRI-first diagnostic pathway, demonstrated a further 10.5–71.3 percent and 22.9–57.3 percent reduction in the number of overdiagnosed PCa cases and MRI scans and biopsies, respectively, at 10-year absolute risk thresholds of 2 percent and 10 percent, whilst generating greater QALYs at all risk thresholds <5 percent,” They noted.

MRI-first risk-tailored screening vs biopsy-first age-based screening prevented a greater number of PCa deaths at a risk threshold of 2 percent, but the PCa deaths prevented were 1.7–15.3 percent less compared with MRI-first age-based screening at risk thresholds of 2 percent and 10 percent, respectively.

All MRI-first risk-tailored screening strategies had a higher net monetary benefit (NMB) than MRI-first age-based screening, as well as incremental cost-effectiveness ratios (ICERs) of <GBP 20,000 (ie, USD 26,000) per QALY gained using a risk threshold of 2.5 percent compared with no screening.  

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Most Read Articles
Dr Margaret Shi, 13 Jul 2020

An MRI-first diagnostic pathway, combined with risk-tailored screening, is shown to improve the benefit-to-harm profile and cost-effectiveness of screening for prostate cancer (PCa), according to results of a recent lifetable modelling study presented at AACR 2020 Virtual Meeting II.

Christina Lau, 14 Jul 2020

Flat-dose nivolumab, administered as a 30-minute infusion, is well tolerated and active in Asian patients with previously treated advanced non-small-cell lung cancer (NSCLC), according to results of the phase IIIb CheckMate 870 study.

Natalia Reoutova, 17 Jul 2020

At a median follow-up of 22.9 months, atezolizumab plus carboplatin and etoposide (CP/ET), given as a first-line treatment, continued to demonstrate an improvement in overall survival (OS) vs placebo plus CP/ET in patients with extensive-stage small-cell lung cancer (ES-SCLC), according to updated results of the IMpower133 trial presented at the American Association for cancer Research (AACR) 2020 Virtual Annual Meeting II.

13 Feb 2020
At the recent National Haematology Expert Meeting 2019, a panel of experts was convened to discuss the role of targeted therapy in the management of haematological malignancies. Highlights of their lectures are summarised below.