Doctors discuss prostate cancer imaging pressure points

If MRI prostagram should prove to be a good screening tool for prostate cancer, urologists are going to have a lot of work on their hands, and radiologists will be needed to overcome this burden, said the U.K. Transform trial's lead investigator during a connecting disciplines session at ECR 2025.

"Everybody's talking about screening," said Transform lead Hashim Ahmed, MD, PhD, a urologist at Imperial College London and Imperial College Healthcare NHS Trust Institution during the multidisciplinary team conversation. "There's a lot to be done in terms of the best approach to finding cancer, which is significant, and we need to do much more to reduce the side effects of treatment."

"We need to get more information from the MRI scan," said Hashim Ahmed, MD, PhD, a urologist at Imperial College London and Imperial College Healthcare NHS Trust Institution.

Now in its initial pilot phase, the 42 million pound ($53 million) U.K. Transform trial involves approximately 12,500 men and will evaluate four potential screening options, including fast MRI scans, genetic testing to identify men at high risk of prostate cancer, and prostate-specific antigen (PSA) blood testing, according to Prostate Cancer UK. A fast MRI is a 12-minute version of the full scan.

Ahmed reflected on the findings of the prostagram study of about 410 men, which demonstrated a short, noncontrast MRI prostagram detected more significant cancers than PSA, the results spurring the U.K.'s Transform trial which will span 10 years. Ahmed noted that Transform will only permit targeted biopsy, rather than systemic biopsy as the trial plays out.

"We need to get more information from the MRI scan," Ahmed added. "We need to work out what the margin of treatment should be ... how best to report MRIs after focal therapy ... and we will be coming up with a consensus approach going forward."

MRI reports include a quality reference remark that precedes the diagnosis, explained radiologist Jelle Barentsz, MD, PhD.

Radiologist Jelle Barentsz, MD, PhD, of Radboud University in the Netherlands, emphasized that poor-quality MRI images are leading to prostate cancer overdiagnosis. Barentsz also suggested decreasing opportunistic screening by standardizing the entire diagnostic path.

"We need to have a quality measurement of the imaging," he explained. "We developed PI-QUAL which is, I think, the first MRI standard looking at image quality. We see that we can deliver in a better way."

Barentsz suggested MRI reports include a quality reference remark that precedes the diagnosis. "There are many scientific presentations, very smart studies," he said, "however nobody mentions image quality. What is the quality of the images I used in my study? Even as reviewers in international journals we are not looking at image quality. Why don't we have a prescription that you need to define your quality in a scientific paper or study?"

Moreover, verifying scans for PI-RAD compliance may also be lacking, but Barentsz cautioned, "even if [a scan] matches the technical requirements, that does not guarantee a good quality image. Technical requirements are good but they're not the only thing."

Marcin Alfred Miszczyk, MD, PhD, a radiation oncologist at Medical University of Vienna, remarked, "With screening, we are very efficient in turning healthy people into patients. If we do have systematic screening, in many cases it's a diagnosis that is just there, but it's not a disease that will ever need to be treated.

"Maybe we should finally address the elephant in the room," Miszczyk said. "Is that cancer? Should we call it that? Maybe we should rename it."

The good news is that there is active surveillance, added Barentsz. "It's insignificant cancer," he said, "but what the patient remembers is, 'I have cancer. What should I do?' You have insignificant cancer that will not harm you, and we will check that with a yearly or, once to two years, an MRI. If something changes, we'll do a biopsy targeted and we are in time. If you put it that way, I think you will reduce anxiety. We should not create anxiety ... PSA, prostate antigen anxiety."

Communication with the radiologist is essential, Barentsz concluded.

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