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://dev.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 Carlsson, MD, PhD, MPH, is an Assistant Attending Epidemiologist at Memorial Sloan Kettering Cancer Center (MSKCC) with 15 years of prostate cancer research experience and over 100 publications. Her PhD thesis stemmed from the world’s largest study of prostate cancer screening, the European Randomized Study of Screening for Prostate Cancer (ERSPC), which investigated how quality of life was affected by screening and treatment. Before pursuing postdoctoral studies in urologic oncology at MSKCC, Dr. Carlsson was a physician in Sweden. She obtained an MPH degree from Harvard T.H. Chan School of Public Health.
Currently, Dr. Carlsson’s research focuses on developing risk-stratified approaches to screening, diagnosis, treatment, and follow-up of prostate cancer patients. She is also the PI of a study funded by the Patty Brisben Foundation to improve the method of asking questions about women’s sexual health. She is a co-investigator on a multi-center study funded by Movember (PI: Andrew J. Vickers, PhD) that evaluates the impact of survivorship care plans and navigation tools on patients with prostate cancer after radiotherapy. She is a co-investigator on two NIH-funded research projects, one of which investigates biomarkers and risk stratification in localized prostate cancer (PI: Hans Lilja, MD, PhD). The second project is focused on developing models to improve prostate cancer outcomes across diverse populations (PI: Ruth Etzioni, PhD).
