In prostate cancer screening, magnetic resonance imaging (MRI) scans have been utilised as the primary modality or as a sequential modality augmented by PSA. This study aims to evaluate cancer detection rates between screening with only MRI scans (‘primary’ MRI) compared to a ‘sequential’ approach (PSA or other biomarkers followed by MRI).

Pubmed, Embase, Web of Science, CENTRAL, Scopus and Google Scholar were searched using variations of three key terms: “MRI”, “prostate cancer”, and “screening” from 01/1/2000 to 20/4/2024. Studies included were those investigating adult males in the general population with no particular risk stratification. The primary outcomes were of cancer detection rate for clinically significant and insignificant prostate cancer.

A total of 17 studies were included for final analysis. Primary MRI had a high cancer detection rate for compared to sequential MRI for any prostate cancer detection (8.49% vs 1.88%, p=0.0223) and clinically significant prostate cancer (5.93% vs 1.15%, p=0.0180). There was no statistically significant difference in the cancer detection rate for clinically insignificant cancer between both groups. In studies directly comparing primary and sequential MRI, primary MRI demonstrated higher odds of detection for any (OR 2.77, 95% CI: 1.71, 4.49), clinically significant (OR 2.32, 95% CI: 1.37, 3.96) and clinically insignificant (OR 3.11, 95% CI: 1.08, 8.97) prostate cancer.

Primary MRI screening picks ups more clinically significant prostate cancer that would be under-detected with initial screening with PSA. In a sequential MRI screening protocol, a lower PSA cut-off may improve cancer screening outcomes but this remains to be confirmed.