FICAN science -webinaari ”Transforming prostate cancer detection: Insights from clinical research in MRI and screening”

Aika: Ke 17.9. klo 15-16 

Aihe: Transforming Prostate Cancer Detection: Insights from Clinical Research in MRI and Screening

Puhuja: Antti Rannikko, urologian professori ja osastonylilääkäri, HUS & Helsingin yliopisto

Tutustu puhujaan:

Antti Rannikko – Helsingin yliopisto

Helsinki Urological Cancer Center

Suomalainen Eturauhassyöpä

Tällä kertaa seminaarin järjestää FICAN South. Seminaari pidetään verkossa (Microsoft Teams), johon voit liittyä suoraan tästä linkistä: Liity kokoukseen nyt

Abstract

Prostate-specific antigen (PSA)–based screening has reduced prostate cancer mortality but at the cost of extensive overdiagnosis and overtreatment. Our research has aimed to transform prostate cancer detection by incorporating magnetic resonance imaging (MRI) and novel biomarkers into both clinical care and population-based screening.

In diagnostic pathways, we demonstrated that MRI-targeted biopsies detect more clinically significant cancers while reducing low-grade diagnoses, patient discomfort, and infectious complications compared with systematic biopsies. At the same time, we identified important caveats: interreader variability in MRI reporting, biopsy grade inflation, and overtreatment of MRI-detected Gleason grade group 2 cancers. Adding MRI to established risk models (CAPRA, MSKCC, Partin) improved prediction of adverse pathology and recurrence after surgery. Molecular and transcriptomic studies further revealed that MRI-visible lesions harbor aggressive features (e.g., FAP expression, PTEN loss), whereas invisible lesions are typically less aggressive. These findings on FAP have led to an ongoing clinical trial evaluating the performance of FAPI as a tracer in PET imaging of prostate cancer.

Most recently, in a multicohort registry study of over 6,000 men from Helsinki, Tampere, and Lille, we showed that PI-RADS score 5 is a strong independent predictor of prostate cancer–specific mortality and other key endpoints, while a negative MRI associates with negligible risk. These findings establish MRI not only as a diagnostic but also as a prognostic tool. Building on this evidence, the Finnish ProScreen randomized trial combines PSA, a kallikrein panel, and MRI in a stepwise protocol. Early results suggest improved detection of high-grade cancers with reduced harms, moving us toward screening strategies that preserve mortality benefit while minimizing overdiagnosis.

Relevat references for this talk:

• V. Kasivisvanathan, A.S. Rannikko, M. Borghi, V. Panebianco, L.A. Mynderse, M.H. Vaarala, A. Briganti, L. Budäus, G. Hellawell, R.G. Hindley, M.J. Roobol, S. Eggener, M. Ghei, A. Villers, F. Bladou, G.M. Villeirs, J. Virdi, S. Boxler, G. Robert, P.B. Singh, W. Venderink, B.A. Hadaschik, A. Ruffion, J.C. Hu, D. Margolis, S. Crouzet, L. Klotz, S.S. Taneja, P. Pinto, I. Gill, C. Allen, F. Giganti, A. Freeman, S. Morris, S. Punwani, N.R. Williams, C. Brew‑Graves, J. Deeks, Y. Takwoingi, M. Emberton, and C.M. Moore, for the PRECISION Study Group Collaborators* MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med 378; 1767 – 1777, 2018
• Anssi Auvinen, Teuvo L. J. Tammela, Tuomas Mirtti, Hans Lilja, Teemu Tolonen, Anu Kenttämies, Irina Rinta-Kiikka, Terho Lehtimäki, Kari Natunen, Jaakko Nevalainen, Jani Raitanen, Johanna Ronkainen, Theodorus van der Kwast, Jarno Riikonen, Anssi Pétas, Mika Matikainen, Kimmo Taari, Tuomas Kilpeläinen, Antti S. Rannikko, for the ProScreen Trial Investigators. Prostate Cancer Screening With PSA, Kallikrein Panel, and MRI The ProScreeb Randomized trial JAMA 331(17); 1452 – 1459, 2024
• Tolou Shadbahr, Juho Pylväläinen, Juho Eineluoto, Alessio Moro, Oleg Kerro, Anu Kenttämies, Eugen Czeizler, Teemu J Murtola, Hyon-Jung Kim-Ollila, Philippe Puech, Jonathan Olivier, Arnauld Villers, Jaakko Peltonen, Matti Nykter, Jing Tang, Tuomas Mirtti, Teemu D. Laajala, Antti S. Rannikko. PI-RADS v2 as a Strong Prognostic Marker for Adverse Outcomes in Prostate Cancer: Multicohort Validation in Finland and France. Submitted (available at: PI-RADS v2 is a Strong Prognostic Marker for Adverse Outcomes in Prostate Cancer | medRxiv)
• Timo-Pekka K. Lehto, Juho Pylväläinen, Kevin Sandeman, Anu Kenttämies, Stig Nordling, Ian G. Mills, Jing Tang, Tuomas Mirtti, Antti Rannikko. Histomic and transcriptomic features of MRI-visible and invisible clinically significant prostate cancers are associated with prognosis. Int J Cancer 154; 926 – 939, 2024