Sigrid V. Carlsson, MD, PhD, MPH, presented “Screening and Prevention of Prostate Cancer 2021 (Part 3): Incorporating MRI for Early Detection” for the Grand Rounds in Urology audience in June 2021.
How to cite: Carlsson, Sigrid V. “Screening and Prevention of Prostate Cancer 2021 (Part 3): Incorporating MRI for Early Detection” June 2021. Accessed Nov 2024. https://grandroundsinurology.com/screening-and-prevention-of-prostate-cancer-2021-part-3-incorporating-mri-for-early-detection/
Screening and Prevention of Prostate Cancer 2021 (Part 3): Incorporating MRI for Early Detection – Summary:
In the final part of a 3-part series, Sigrid V. Carlsson, MD, PhD, MPH, Assistant Attending Epidemiologist at Memorial Sloan Kettering Cancer Center, considers the current role of MRI in early detection of prostate cancer. She notes that while the various major prostate cancer guidelines recommend using multiparametric (mp)MRI before biopsy, they do not recommend using it as an initial screening tool. Also, while the EAU guidelines suggest that systematic biopsies can be omitted in patients with negative mpMRIs, the evidence for doing so is weak, and the NCCN guidelines take the more conservative approach of advocating for the inclusion of systematic biopsy with mpMRI. Dr. Carlsson continues by analyzing some of these limitations of mpMRI, explaining that its accuracy is highly dependent on the expertise of who is reading it. For this reason, it may be too early to omit biopsies in men with negative MRIs unless the MRI was performed at a specialized clinic. Furthermore, Dr. Carlsson notes, many of the studies showing the benefit of mpMRI were performed at centers of excellence, and may not reflect the limitations of most institutions. She opines that a chain is only as strong as its weakest link, and notes that pre-biopsy MRI requires access to high-quality mpMRI studies, optimal reading of scans, and access to high-quality mpMRI-targeted biopsy in order to truly be successful. Dr. Carlsson concludes by listing a variety of ongoing studies into imaging for prostate cancer screening and noting that evidence suggests unnecessary biopsies may be reduced in the future by combining mpMRI and different biomarker tests.
Part 1 of this series, covering PSA screening, can be seen here. Part 2, on patient selection for biopsy, is available here.
ABOUT THE AUTHOR
Sigrid V. Carlsson, MD, PhD, MPH, is Director of Clinical Research at Memorial Sloan Kettering Cancer Center’s (MSKCC) Josie Robertson Surgery Center and Assistant Attending Epidemiologist, with dual appointments in MSKCC’s Departments of Surgery (Urology Service) and Epidemiology and Biostatistics. Her line of research focuses on screening and early detection of prostate cancer, including multiplex testing and risk-stratified strategies that incorporate clinical information, biomarkers and magnetic resonance imaging, as recently funded by an NIH/NCI U01 award (PI: Carlsson).
Dr. Carlsson also serves as Associate Professor of Experimental Urology affiliated with the Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, in Sweden, where she is an investigator of two large randomized controlled trials of prostate cancer screening (GOTEBORG-1&2), as recently published in the New England Journal of Medicine (Hugosson J, et al. N Engl J Med 2022). In addition, Dr. Carlsson is Adjunct Senior Lecturer in the Department of Translational Medicine in the Division of Urological Cancers in the Medical Faculty at Lund University, Lund, Sweden.
Dr. Carlsson recently completed a K22 career development award from the NIH/NCI to improve shared decision-making for breast and prostate cancer screening. She serves on the National Comprehensive Cancer Network (NCCN) and is a panel member for the American Urological Association (AUA) guidelines for early detection of prostate cancer. Before pursuing postdoctoral studies in urologic oncology at MSKCC, Dr. Carlsson was a physician in Sweden. She earned her MD and PhD from Gothenburg University in Sweden and earned an MPH from Harvard TH Chan School of Public Health in Boston, Massachusetts.
