{"entity":{"id":"idea-prev-mri-first-prostate-screening-prs","kind":"idea","name":"MRI-first prostate screening with genetic pre-selection","aka":[],"tldr":"PSA screening finds harmless prostate cancers that would never cause trouble. Selecting men by PSA plus a polygenic risk score, then MRI before any biopsy and targeted biopsy only for PI-RADS 4 to 5 lesions, finds the dangerous cancers and skips the rest; GOTEBORG-2 showed MRI-targeted biopsy halves overdiagnosis.","summary":"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.","asOf":"2026-09-08","links":[{"label":"Prostate Cancer UK (TRANSFORM)","url":"https://prostatecanceruk.org"}],"tags":[],"related":["prostate-roadmap","idea-prostate-metastatic-presentation-as-the-screening-endpoint","idea-prostate-per-lesion-mri-audit-before-focal-treatment"],"cancers":["prostate"],"sections":["early-detection","imaging"],"technologies":["mri","germline-testing"],"targets":[],"drugs":[],"companies":[],"institutions":["icr-london"],"pathways":[],"terms":["polygenic-risk-score","pi-rads"],"trials":[],"people":[],"bottlenecks":["b-early-detection","b-overdiagnosis"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"The combined pathway detects clinically significant (Gleason 7 and above) cancer at rates similar to PSA screening while cutting Gleason 6 detection by at least half and biopsies by at least 40%.","rationale":"Each component has randomised support; the combination is the programme design step.","test":"Embedded arm in TRANSFORM or a national pilot.","maturity":"being-tested-at-scale","actor":"policy","cost":"large","horizonYears":6},"route":"/ideas/idea-prev-mri-first-prostate-screening-prs/","neighbours":{"roadmap":[{"id":"prostate-roadmap","kind":"roadmap","name":"Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch","route":"/roadmaps/prostate-roadmap/"}],"idea":[{"id":"idea-prostate-metastatic-presentation-as-the-screening-endpoint","kind":"idea","name":"Judge a prostate screening programme on metastatic presentation, not on incidence or mortality","route":"/ideas/idea-prostate-metastatic-presentation-as-the-screening-endpoint/"},{"id":"idea-prostate-per-lesion-mri-audit-before-focal-treatment","kind":"idea","name":"Publish a per-lesion miss rate for every prostate MRI service before it is allowed to guide focal treatment","route":"/ideas/idea-prostate-per-lesion-mri-audit-before-focal-treatment/"}],"cancer":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"},{"id":"imaging","kind":"section","name":"Imaging","route":"/fronts/imaging/"}],"technology":[{"id":"germline-testing","kind":"technology","name":"Germline (hereditary) testing","route":"/technologies/germline-testing/"},{"id":"mri","kind":"technology","name":"MRI","route":"/technologies/mri/"}],"institution":[{"id":"icr-london","kind":"institution","name":"The Institute of Cancer Research","route":"/institutions/icr-london/"}],"term":[{"id":"pi-rads","kind":"term","name":"PI-RADS (Prostate Imaging Reporting and Data System)","route":"/terms/pi-rads/"},{"id":"polygenic-risk-score","kind":"term","name":"Polygenic risk score (PRS)","route":"/terms/polygenic-risk-score/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"paper":[{"id":"paper-conti-trans-ancestry-gwas-prostate-nat-genet-2021","kind":"paper","name":"Trans-ancestry genome-wide association meta-analysis of prostate cancer identifies new susceptibility loci and informs genetic risk prediction","route":"/key-papers/paper-conti-trans-ancestry-gwas-prostate-nat-genet-2021/"}]}}