Evidence map›Paper›PMID 41711881›Full record

ArticleEuropean radiology2026

Diagnostic accuracy of a 'stage-gated' approach for reporting prostate screening MRI: "Is less more?"

Natasha Thorley, Tom Parry, Giorgio Brembilla, Francesco Giganti, Tristan Barrett, David Eldred-Evans, Nikhil Mayor, Alistair Lamb, Penny L Hubbard Cristinacce, Fiona Gong and 7 more

Registry-linked trialAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03702439 (Prostate Cancer Screening Trial Using A Group of Radiological Approaches Including MRI and Ultrasound), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03702439 completednot on this map

Prostate Cancer Screening Trial Using A Group of Radiological Approaches Including MRI and Ultrasound

TypeobservationalSponsorImperial College LondonRan2018 to 2019Enrolled411ConditionsProstate Neoplasm
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors.

Natasha ThorleyCentre for Medical Imaging, University College London, London, UK.
Tom ParryCentre for Medical Imaging, University College London, London, UK.
Giorgio BrembillaCentre for Medical Imaging, University College London, London, UK.
Francesco GigantiDepartment of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
Tristan BarrettDepartment of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
David Eldred-EvansDivision of Surgery, Imperial College London, London, UK.
Nikhil MayorDivision of Surgery, Imperial College London, London, UK.
Alistair LambCentre for Medical Imaging, University College London, London, UK.
Penny L Hubbard CristinacceCentre for Medical Imaging, University College London, London, UK.
Fiona GongCentre for Medical Imaging, University College London, London, UK.
Henry H TamDepartment of Radiology, Imperial College Healthcare NHS Trust, London, UK.
Heminder K SokhiDepartment of Radiology, The Hillingdon Hospitals NHS Foundation Trust, London, UK.
Anwar R PadhaniPaul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK.
Caroline M MooreDivision of Surgical and Interventional Science, University College London, London, UK.
David AtkinsonCentre for Medical Imaging, University College London, London, UK.
Hashim U AhmedDivision of Surgery, Imperial College London, London, UK.
Shonit PunwaniCentre for Medical Imaging, University College London, London, UK. s.punwani@ucl.ac.uk.ORCID http://orcid.org/0000-0001-9865-0260

Funding

National Institute for Health and Care Research (NIHR) NIHR303144
6 · The paper itself

Abstract

objectivesTo evaluate whether a two-step, 'stage-gated' reporting approach could improve the positive predictive value (PPV) of biparametric (bp)MRI for prostate cancer (PCa) screening compared to conventional Likert/PI-RADS scoring. MATERIALS AND

methodsThis retrospective secondary analysis utilised data from IP1-PROSTAGRAM-a prospective, population-based study of men aged 50-69 years who underwent PCa screening with bpMRI, ultrasound and prostate-specific antigen (PSA) testing between October 2018 and May 2019 at two centres (NCT03702439). MRI scans from IP1-PROSTAGRAM were retrospectively evaluated using the 'stage-gated' approach: three radiologists independently reviewed limited MRI sequences (axial T2-weighted and b1500 diffusion-weighted images) and classified scans as positive or negative; if positive, the remaining bpMRI images were reviewed and a hypothetical "decision-to-biopsy" made. The PPV of 'stage-gated' reading was compared to PI-RADS and Likert scores ≥ 4 from the original IP1-PROSTAGRAM bpMRI reports. The reference standard was IP1-PROSTAGRAM biopsy results with grade group (GG) ≥ 2 cancer considered significant.

resultsOf 408 participants (median age 57 years [IQR 53, 61]), 405 had MRI scans available for secondary analysis. The prevalence of GG ≥ 2 cancer was 4% (17/405). The 'stage-gated' reporting approach achieved a PPV of 53% (95% CI: 30, 75; 8/15), compared to 29% (95% CI: 15, 47; 8/28) and 30% (95% CI: 17, 46; 11/37) for Likert and PI-RADS ≥ 4 pathways, respectively. The 'stage-gated' approach halved the number of recommended biopsies while maintaining similar cancer detection rates.

conclusionThe 'stage-gated' reporting approach, using limited sequences for the initial read, may improve the PPV and benefit-to-harm ratio of MRI-based screening. KEY POINTS: Question The PPV of MRI in PCa screening is low, likely because conventional assessment systems are not optimised for low disease prevalence populations. Findings A two-step, 'stage-gated' reading approach achieved a PPV of 53% (8/15), compared to 29% (8/28) for Likert and 30% (11/37) for PI-RADS scores ≥ 4. Clinical relevance The 'stage-gated' reporting approach, which uses limited sequences for the initial read, may improve the PPV and benefit-to-harm ratio of MRI-based screening by reducing unnecessary biopsies. Prospective evaluation is needed to confirm these findings in real-world screening settings.

Indexed as

Magnetic Resonance ImagingProstatic NeoplasmsAgedEarly Detection of CancerHumansMaleMiddle AgedPredictive Value of TestsProspective StudiesProstateProstate-Specific AntigenReproducibility of ResultsRetrospective StudiesSensitivity and SpecificityProstate-Specific AntigenMagnetic resonance imagingMass screeningProstateProstatic neoplasms

Identifiers

PMID41711881
PMCPMC13282289

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.