The role magnetic resonance imaging (MRI) as a first-line screening test for prostate cancer is unknown. We conducted a pilot study to evaluate the feasibility of prostate MRI as the primary screening test for prostate cancer.

We recruited unselected men from the general population and performed multiparametric prostate MRI and random or targeted biopsies on all patients in addition to prostate specific antigen (PSA) testing. We compared the performance of prostate MRI and PSA test results in predicting the presence of prostate cancer.

Among 47 patients recruited, 18 (38.3%) had cancer, while 29 (61.7%) had no evidence of cancer. The adjusted odds ratio for having prostate cancer was significantly higher for MRI score (2.7, 95% C.I.: 1.4-5.4, p=0.004) than PSA level (1.1, 95% C.I.: 0.9-1.4, p=0.21). Among the 30 patients with a normal PSA level (<4.0 ng/mL), the positive predictive value (PPV) for patients with an MRI score of 4 or more was 66.7% (6 of 9) and the negative predictive value (NPV) for patients with an MRI score of 3 or less was 85.7% (18 of 21, p=0.004).

In this pilot study, we demonstrate the feasibility of using multiparametric prostate MRI as the primary screening test for prostate cancer. Initial results show that prostate MRI is better in predicting prostate cancer than PSA among an unselected sample of the general population.