{"doi":"10.1056/nejmoa2209454","title":"Prostate Cancer Screening with PSA and MRI Followed by Targeted Biopsy Only","abstract":"BACKGROUND: Screening for prostate cancer is burdened by a high rate of overdiagnosis. The most appropriate algorithm for population-based screening is unknown. METHODS: We invited 37,887 men who were 50 to 60 years of age to undergo regular prostate-specific antigen (PSA) screening. Participants with a PSA level of 3 ng per milliliter or higher underwent magnetic resonance imaging (MRI) of the prostate; one third of the participants were randomly assigned to a reference group that underwent systematic biopsy as well as targeted biopsy of suspicious lesions shown on MRI. The remaining participants were assigned to the experimental group and underwent MRI-targeted biopsy only. The primary outcome was clinically insignificant prostate cancer, defined as a Gleason score of 3+3. The secondary outcome was clinically significant prostate cancer, defined as a Gleason score of at least 3+4. Safety was also assessed. RESULTS: Of the men who were invited to undergo screening, 17,980 (47%) participated in the trial. A total of 66 of the 11,986 participants in the experimental group (0.6%) received a diagnosis of clinically insignificant prostate cancer, as compared with 72 of 5994 participants (1.2%) in the reference group, a difference of -0.7 percentage points (95% confidence interval [CI], -1.0 to -0.4; relative risk, 0.46; 95% CI, 0.33 to 0.64; P<0.001). The relative risk of clinically significant prostate cancer in the experimental group as compared with the reference group was 0.81 (95% CI, 0.60 to 1.1). Clinically significant cancer that was detected only by systematic biopsy was diagnosed in 10 participants in the reference group; all cases were of intermediate risk and involved mainly low-volume disease that was managed with active surveillance. Serious adverse events were rare (<0.1%) in the two groups. CONCLUSIONS: The avoidance of systematic biopsy in favor of MRI-directed targeted biopsy for screening and early detection in persons with elevated PSA levels reduced the risk of overdiagnosis by half at the cost of delaying detection of intermediate-risk tumors in a small proportion of patients. (Funded by Karin and Christer Johansson's Foundation and others; GÖTEBORG-2 ISRCTN Registry number, ISRCTN94604465.).","journal":"New England Journal of Medicine","year":2022,"id":231871,"datarank":8.33093873322571,"base_score":5.902633333401366,"endowment":5.902633333401366,"self_citation_contribution":0.885395000010205,"citation_network_contribution":7.445543733215505,"self_endowment_contribution":0.885395000010205,"citer_contribution":7.445543733215505,"corpus_percentile":null,"corpus_rank":null,"citation_count":365,"citer_count":100,"citers_with_citation_signal":100,"citers_with_endowment":100,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9302,"is_data_producer":true,"deposit_databanks":{"ISRCTN":["ISRCTN94604465"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":839794,"name":"Marianne Månsson","orcid":"0000-0002-1460-4062","position":1,"is_corresponding":false},{"id":839795,"name":"Jonas Wallström","orcid":"0000-0002-4453-6718","position":2,"is_corresponding":false},{"id":839796,"name":"Ulrika Axcrona","orcid":"0000-0003-1622-954X","position":3,"is_corresponding":false},{"id":253868,"name":"Sigrid Carlsson","orcid":"0000-0003-3553-5710","position":4,"is_corresponding":false},{"id":79750,"name":"Lars Egevad","orcid":"0000-0001-8531-222X","position":5,"is_corresponding":false},{"id":840967,"name":"Kjell Geterud","orcid":null,"position":6,"is_corresponding":false},{"id":839797,"name":"Ali Khatami","orcid":"0000-0002-2212-2311","position":7,"is_corresponding":false},{"id":839798,"name":"Kimia Kohestani","orcid":"0000-0003-0244-5508","position":8,"is_corresponding":false},{"id":840968,"name":"Carl‐Gustaf Pihl","orcid":null,"position":9,"is_corresponding":false},{"id":840969,"name":"Andreas Socratous","orcid":null,"position":10,"is_corresponding":false},{"id":447895,"name":"Johan Stranne","orcid":"0000-0002-4295-6524","position":11,"is_corresponding":false},{"id":839799,"name":"Rebecka Arnsrud Godtman","orcid":"0000-0003-2061-6550","position":12,"is_corresponding":false},{"id":839800,"name":"Mikael Hellström","orcid":"0000-0003-4031-332X","position":13,"is_corresponding":false},{"id":350627,"name":"Jonas Hugosson","orcid":"0000-0002-2324-2817","position":0,"is_corresponding":true}],"reference_count":41,"raw_metadata":null,"created_at":"2026-07-19T00:20:51.245255Z","pmid":"36477032","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}