First-Line PSA Testing More Cost-Effective Than First-Line MRI for Prostate Cancer Screening

Current prostate cancer (PCa) screening protocols typically begin with prostate-specific antigen (PSA) testing, which, if elevated, may lead to further assessment using multiparametric magnetic resonance imaging (mpMRI). Now, a cost-effectiveness analysis has revealed that using biparametric magnetic resonance imaging (bpMRI) as an initial screening tool is less cost-effective than the traditional approach of first-line PSA testing followed by mpMRI. This conclusion held true even when assuming no cost for bpMRI, indicating that the financial savings do not compensate for the drawbacks of using the first-line MRI approach.

A team of researchers from Fred Hutchinson Cancer Center (Seattle, WA, USA), in collaboration with other institutions, developed a microsimulation model to compare the effectiveness and cost-efficiency of first-line bpMRI versus first-line PSA with reflex mpMRI for prostate cancer screening. The study showed that initiating screening with MRI significantly increased the incidence of false positives, unnecessary prostate biopsies, and overdiagnoses, without a corresponding significant decrease in prostate cancer mortality. The findings suggest that even free bpMRI screening does not offer economic or quality-of-life advantages over the conventional approach of PSA testing followed by mpMRI and, if necessary, MRI-guided prostate biopsy supplemented by transrectal ultrasonography–guided biopsy.

These results underline the importance of focusing screening strategies on minimizing false positives and overdiagnoses to enhance cost-effectiveness. High-quality cost-effectiveness analyses like this are vital for understanding how changes in medical practice impact the broader healthcare system. Moreover, incorporating economic data from such analyses could strengthen the development of guidance statements, as endorsed by the National Comprehensive Cancer Network. It is recommended that other organizations also consider integrating cost-effectiveness information into their guidelines to inform clinical decisions.

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Fred Hutchinson Cancer Center

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