MRI-guided versus standard biopsy in prostate cancer screening

High rates of overdiagnosis are a critical barrier to organized prostate cancer screening. The STHLM3 study in Sweden randomized men (aged 50-74 years) with PSA 3 ng/ml or higher to standard biopsy or MRI followed by standard biopsy if the MRI results suggested prostate cancer. Clinically significant prostate cancer (Gleason score 7 or higher) was detected in 21% of the men in the MRI group versus 18% in the standard group (difference, 3 percentage points; 95% CI -1 to 7; p<0.001 for noninferiority). Clinically insignificant prostate cancer was detected in 4% of the men in the MRI group versus 12% in the standard group (difference, -8 percentage points; 95% CI -11 to -5). The authors conclude that MRI-guided biopsy was noninferior to standard biopsy for detecting clinically significant prostate cancer and resulted in less frequent detection of clinically insignificant prostate cancer.