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A Comparison of Magnetic Resonance Imaging Assessment and Biopsy Outcomes with and Without Central Review in Two Swedish Regional Organized Prostate Cancer Testing Programs

Wallström, Jonas ; Alterbeck, Max LU ; Godtman, Rebecka Arnsrud ; Bratt, Ola LU ; Jiborn, Thomas LU and Thimansson, Erik LU (2025) In European Urology Open Science 77. p.32-38
Abstract

Background and objective: The European Council advises evaluating the feasibility of organized prostate cancer testing (OPT) programs, but it is unclear whether results from screening trials can be replicated in population-based testing. The aim of this study is to compare magnetic resonance imaging (MRI) assessments and biopsy outcomes with and without a central review in two Swedish OPT programs. Methods: Two regional population-based OPT programs invited 65 000 men (2020–2022). MRI scans were read locally, and biopsies followed a strict MRI-based and prostate-specific antigen (PSA) density–based protocol. A blinded central review was done by two radiologists with 8 and 9 yr of experience. Reader agreement was assessed with... (More)

Background and objective: The European Council advises evaluating the feasibility of organized prostate cancer testing (OPT) programs, but it is unclear whether results from screening trials can be replicated in population-based testing. The aim of this study is to compare magnetic resonance imaging (MRI) assessments and biopsy outcomes with and without a central review in two Swedish OPT programs. Methods: Two regional population-based OPT programs invited 65 000 men (2020–2022). MRI scans were read locally, and biopsies followed a strict MRI-based and prostate-specific antigen (PSA) density–based protocol. A blinded central review was done by two radiologists with 8 and 9 yr of experience. Reader agreement was assessed with percentages and kappa scores. Positive predictive values (PPVs) for detecting grade group (GG) 2–5 prostate cancer were calculated with 95% confidence intervals (CIs). Key findings and limitations: MRI scans for 416 men (median age 52 yr) with PSA ≥3 ng/ml were evaluated. In Skåne, 27% of scans were primarily assigned Prostate Imaging Reporting and Data System (PI-RADS) scores ≥4, compared with 10% in Västra Götaland. At the primary reading, 76 men had PI-RADS ≥4, yielding 43 GG 2–5 prostate cancer cases: PPV 0.57 (95% CI 0.45–0.67). At the central review, 65 men had PI-RADS ≥4. Out of 61 men biopsied, 50 had GG 2–5 prostate cancer: PPV 0.82 (95% CI 0.71–0.90, p < 0.001 for PPV difference). The central review radiologists’ kappa score was 0.83. No additional biopsies were taken based on the central review findings. Conclusions and clinical implications: In population-based screening with local MRI reading, MRI assignment may vary substantially. Centralized reading could reduce these differences and increase the biopsy PPV for GG ≥2 cancer. Patient summary: In this report, we reviewed local magnetic resonance imaging (MRI) reading in population-based screening. We found that MRI assignment varied between centers. We conclude that centralized reading could reduce differences and improve biopsy outcomes.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Early detection of cancer, Magnetic resonance imaging, Observer variation, Prostatic neoplasms
in
European Urology Open Science
volume
77
pages
7 pages
publisher
Elsevier
external identifiers
  • pmid:40528941
  • scopus:105007310125
ISSN
2666-1691
DOI
10.1016/j.euros.2025.05.008
language
English
LU publication?
yes
id
912cfdaa-fbca-40c4-9b24-95fa764081b3
date added to LUP
2026-01-08 11:29:20
date last changed
2026-01-09 03:00:07
@article{912cfdaa-fbca-40c4-9b24-95fa764081b3,
  abstract     = {{<p>Background and objective: The European Council advises evaluating the feasibility of organized prostate cancer testing (OPT) programs, but it is unclear whether results from screening trials can be replicated in population-based testing. The aim of this study is to compare magnetic resonance imaging (MRI) assessments and biopsy outcomes with and without a central review in two Swedish OPT programs. Methods: Two regional population-based OPT programs invited 65 000 men (2020–2022). MRI scans were read locally, and biopsies followed a strict MRI-based and prostate-specific antigen (PSA) density–based protocol. A blinded central review was done by two radiologists with 8 and 9 yr of experience. Reader agreement was assessed with percentages and kappa scores. Positive predictive values (PPVs) for detecting grade group (GG) 2–5 prostate cancer were calculated with 95% confidence intervals (CIs). Key findings and limitations: MRI scans for 416 men (median age 52 yr) with PSA ≥3 ng/ml were evaluated. In Skåne, 27% of scans were primarily assigned Prostate Imaging Reporting and Data System (PI-RADS) scores ≥4, compared with 10% in Västra Götaland. At the primary reading, 76 men had PI-RADS ≥4, yielding 43 GG 2–5 prostate cancer cases: PPV 0.57 (95% CI 0.45–0.67). At the central review, 65 men had PI-RADS ≥4. Out of 61 men biopsied, 50 had GG 2–5 prostate cancer: PPV 0.82 (95% CI 0.71–0.90, p &lt; 0.001 for PPV difference). The central review radiologists’ kappa score was 0.83. No additional biopsies were taken based on the central review findings. Conclusions and clinical implications: In population-based screening with local MRI reading, MRI assignment may vary substantially. Centralized reading could reduce these differences and increase the biopsy PPV for GG ≥2 cancer. Patient summary: In this report, we reviewed local magnetic resonance imaging (MRI) reading in population-based screening. We found that MRI assignment varied between centers. We conclude that centralized reading could reduce differences and improve biopsy outcomes.</p>}},
  author       = {{Wallström, Jonas and Alterbeck, Max and Godtman, Rebecka Arnsrud and Bratt, Ola and Jiborn, Thomas and Thimansson, Erik}},
  issn         = {{2666-1691}},
  keywords     = {{Early detection of cancer; Magnetic resonance imaging; Observer variation; Prostatic neoplasms}},
  language     = {{eng}},
  pages        = {{32--38}},
  publisher    = {{Elsevier}},
  series       = {{European Urology Open Science}},
  title        = {{A Comparison of Magnetic Resonance Imaging Assessment and Biopsy Outcomes with and Without Central Review in Two Swedish Regional Organized Prostate Cancer Testing Programs}},
  url          = {{http://dx.doi.org/10.1016/j.euros.2025.05.008}},
  doi          = {{10.1016/j.euros.2025.05.008}},
  volume       = {{77}},
  year         = {{2025}},
}