| Title: |
Diagnostic accuracy of a ‘stage-gated’ approach for reporting prostate screening MRI: “Is less more?” |
| Authors: |
Thorley, N; Parry, T; Brembilla, G; Giganti, F; Barrett, T; Eldred-Evans, D; Mayor, N; Lamb, A; Hubbard Cristinacce, PL; Gong, F; Tam, HH; Sokhi, HK; Padhani, AR; Moore, CM; Atkinson, D; Ahmed, HU; Punwani, S |
| Publisher Information: |
Springer |
| Publication Year: |
2026 |
| Collection: |
Oxford University Research Archive (ORA) |
| Description: |
Objectives: To evaluate whether a two-step, ‘stage-gated’ reporting approach could improve the positive predictive value (PPV) of biparametric (bp)MRI for prostate cancer (PCa) screening compared to conventional Likert/PI-RADS scoring. Materials and methods: This retrospective secondary analysis utilised data from IP1-PROSTAGRAM—a prospective, population-based study of men aged 50–69 years who underwent PCa screening with bpMRI, ultrasound and prostate-specific antigen (PSA) testing between October 2018 and May 2019 at two centres (NCT03702439). MRI scans from IP1-PROSTAGRAM were retrospectively evaluated using the ‘stage-gated’ approach: three radiologists independently reviewed limited MRI sequences (axial T2-weighted and b1500 diffusion-weighted images) and classified scans as positive or negative; if positive, the remaining bpMRI images were reviewed and a hypothetical “decision-to-biopsy” made. The PPV of ‘stage-gated’ reading was compared to PI-RADS and Likert scores ≥ 4 from the original IP1-PROSTAGRAM bpMRI reports. The reference standard was IP1-PROSTAGRAM biopsy results with grade group (GG) ≥ 2 cancer considered significant. Results: Of 408 participants (median age 57 years [IQR 53, 61]), 405 had MRI scans available for secondary analysis. The prevalence of GG ≥ 2 cancer was 4% (17/405). The ‘stage-gated’ reporting approach achieved a PPV of 53% (95% CI: 30, 75; 8/15), compared to 29% (95% CI: 15, 47; 8/28) and 30% (95% CI: 17, 46; 11/37) for Likert and PI-RADS ≥ 4 pathways, respectively. The ‘stage-gated’ approach halved the number of recommended biopsies while maintaining similar cancer detection rates. Conclusion: The ‘stage-gated’ reporting approach, using limited sequences for the initial read, may improve the PPV and benefit-to-harm ratio of MRI-based screening. Key Points: Question The PPV of MRI in PCa screening is low, likely because conventional assessment systems are not optimised for low disease prevalence populations. Findings A two-step, ‘stage-gated’ reading approach achieved a PPV of ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1007/s00330-025-12250-4 |
| Availability: |
https://doi.org/10.1007/s00330-025-12250-4; https://ora.ox.ac.uk/objects/uuid:54a1528b-9fdb-4222-9577-bd0cc2e14a25 |
| Rights: |
info:eu-repo/semantics/openAccess ; CC Attribution (CC BY) |
| Accession Number: |
edsbas.4FF1CC90 |
| Database: |
BASE |