First-Line Biparametric MRI Less Cost-Effective Than PSA for Prostate Cancer Screening

First-line PSA screening remained cost-effective even if bpMRI was free and all men with low-risk prostate cancer underwent surveillance
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MONDAY, June 3, 2024 (HealthDay News) -- From an economic perspective, first-line prostate-specific antigen (PSA) testing is favored over biparametric magnetic resonance imaging (bpMRI) for prostate cancer screening, mainly due to false-positive results and overdiagnosis, according to a study published online June 4 in the Annals of Internal Medicine.

Roman Gulati, from the Fred Hutchinson Cancer Center in Seattle, and colleagues examined the comparative effectiveness and cost-effectiveness of first-line bpMRI versus PSA-based screening in a decision analysis using a microsimulation model. The target population comprised U.S. men aged 55 years without prior screening or prostate cancer diagnosis.

The researchers found that first-line bpMRI versus PSA testing prevented two to three prostate cancer deaths and added 10 to 30 life-years per 1,000 men, but, depending on the biopsy imaging scheme, increased the number of biopsies by 1,506 to 4,174 and the number of overdiagnoses by 38 to 124. The greatest net monetary benefits were seen for first-line PSA testing with multiparametric MRI followed by either biopsy approach for Prostate Imaging Reporting and Data System 4 to 5 at conventional cost-effectiveness thresholds. In sensitivity analysis, even if bpMRI was free, all men with low-risk prostate cancer underwent surveillance, and screening was quadrennial, first-line PSA still remained cost-effective.

"Our analyses suggest that the economic value of a first-line screening test, such as bpMRI, is driven by false-positive results and overdiagnoses rather than the cost of the test," the authors write. "Accordingly, our results suggest that screening efforts should focus on strategies that reduce false-positive results and overdiagnoses to improve cost-effectiveness."

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