Evaluation shows that a stage-gated biparametric MRI improves positive predictive value in prostate cancer screening, indicating potential to reduce unnecessary biopsies.
Motivation: Prostate MRI is a promising screening tool for prostate cancer, but it has a low positive predictive value (PPV), likely because assessment systems are not optimised for low disease prevalence. Goal(s): To evaluate whether a novel two-step, 'stage-gated' biparametric (bp)MRI reporting approach improves the PPV compared to conventional Likert/PI-RADS scoring designed for multiparametric (mp)MRI reading. Approach: 405 MRI scans from IP1-PROSTAGRAM underwent retrospective 'stage-gated' reporting: limited screening sequences (T2-weighted and b1500 diffusion-weighted images) were reviewed first, followed by the remaining bpMRI sequences if positive. Results: The 'stage-gated' bpMRI approach improved the PPV compared to bpMRI Likert/PI-RADS≥4 scoring and halved the number of biopsies. Impact: A 'stage-gated' reporting approach for prostate MRI screening improves the positive predictive value (PPV) compared to Likert/PI-RADS scoring while maintaining comparable cancer detection rates. This approach may prove valuable in reducing unnecessary biopsies in future prostate cancer screening trials.
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Thorley et al. (2025) studied this question.
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