MRI-first prostate screening with genetic pre-selection
PSA screening finds too many harmless cancers. Using PSA plus a genetic risk score to select men, and MRI before any biopsy, finds the dangerous ones and skips the rest.
GOTEBORG-2 showed MRI-targeted biopsy halves overdiagnosis; BARCODE1 showed polygenic-score-selected men have high rates of clinically significant cancer. The UK TRANSFORM trial will compare pathways. Propose a national screening design combining PRS/PSA pre-selection, MRI, and targeted biopsy only for PI-RADS 4-5 lesions.
- Most lethal cancers are found late · Screening exists for only a few cancers. Pancreatic, ovarian, liver, oesophageal and most lung cancers are found when cure is unlikely.
- Overdiagnosis and false alarms · Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them.
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not linked directly; found by shared links- IdeaUse a polygenic risk score to set when screening starts
Shares The Institute of Cancer Research, Germline (hereditary) testing, Most lethal cancers are found late, Prostate cancer.
- IdeaProstate active surveillance without scheduled biopsies: MRI and blood tests decide
Shares MRI, Overdiagnosis and false alarms, Prostate cancer.
- IdeaStop watching stable low-risk pancreatic cysts after five years
Shares MRI, Overdiagnosis and false alarms.
- IdeaA ten-year cohort of incidental findings to calibrate follow-up guidelines
Shares MRI, Overdiagnosis and false alarms.
- TechnologyMultiparametric prostate MRI (PI-RADS)
Shares MRI, Overdiagnosis and false alarms, Prostate cancer.
- IdeaTest whether calling Gleason 6 'not cancer' changes what men choose
- IdeaModern autopsy studies to measure how much silent cancer people carry
- IdeaCertified decision aids required for every preference-sensitive cancer decision