Magnetic resonance imaging (MRI) and targeted biopsies reduce overdiagnosis of prostate cancer (PC). It is uncertain how this strategy performs for low prostate-specific antigen (PSA) levels. To investigate the Prostate Imaging Reporting and Data System (PI-RADS) distribution, frequency, and characteristics of screen-detected PC with PSA of 1.8–<3 ng/ml and 3–<10 ng/ml. In the population-based Göteborg-2 screening study, 17974 men choose to participate by having a PSA test (2015–2020). One-third of the participants ( = 6006) were randomized to arm 3, men with a PSA value of ≥1.8 ng/ml were recommended for MRI. Men with positive MRI (PI-RADS 3–5) had four targeted biopsies from each MRI-visible lesion. Clinically significant PC was defined as Gleason score ≥3 + 4. A total of 6006 men were included. The median age was 55.9 yr (interquartile range [IQR] 52.6–59.6). Of them, 4929 (82%) had PSA of <1.8 ng/ml, 670 (11%) had PSA of 1.8–<3 ng/ml (low-PSA group, median PSA 2.1 ng/ml [IQR 1.9–2.5]), and 377 (6.3%) had PSA of 3–<10 ng/ml (high-PSA group, median PSA 3.9 ng/ml [IQR 3.3–5.0]). PI-RADS scores of 3, 4, and 5 were observed in 7.8%, 15%, and 1.0% of men in the low-PSA group, and in 6.9%, 17%, and 5.3% of men in the high-PSA group, respectively. PC was found in 64 men (41%, 95% confidence interval [CI] 0.33–0.49) with positive MRI findings in the low-PSA group, of whom 33 (21%) had Gleason 6 (insignificant PC) and 31 (20%) had Gleason ≥7 (significant PC). In the high-PSA group, PC was detected in 61 men (56%, 95% CI 0.46–0.66), of whom 26 (24%) had Gleason 6 (insignificant PC) and 35 (32%) had Gleason ≥7 (significant PC). Limitations include results from only a single screening round. A non-negligible number of men with PSA 1.8–3 ng/ml have clinically significant PC. Whether a delay in the diagnosis of these tumors until they reached PSA ≥3 ng/ml would impair their chance of cure remains to be evaluated. We studied screening using prostate-specific antigen (PSA) and magnetic resonance imaging in men with PSA 1.8–3 ng/ml. We found a non-negligible number of potentially harmful prostate cancers in these men.

中文翻译：

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前列腺特异性抗原区间为 1.8–3 ng/ml 的前列腺癌：Göteborg-2 前列腺癌筛查试验的结果

磁共振成像 (MRI) 和靶向活检可减少前列腺癌 (PC) 的过度诊断。目前还不确定该策略对于低前列腺特异性抗原 (PSA) 水平的效果如何。旨在调查前列腺影像报告和数据系统 (PI-RADS) 的分布、频率和屏幕检测到 PSA 为 1.8–<3 ng/ml 和 3–<10 ng/ml 的 PC 的特征。在基于人群的 Göteborg-2 筛查研究中，17974 名男性选择通过 PSA 测试参与（2015-2020 年）。三分之一的参与者 (= 6006) 被随机分配到第 3 组，建议 PSA 值≥1.8 ng/ml 的男性进行 MRI 检查。 MRI 呈阳性的男性 (PI-RADS 3-5) 对每个 MRI 可见病变进行了四次有针对性的活检。有临床意义的 PC 定义为格里森评分≥3 + 4。总共纳入了 6006 名男性。中位年龄为 55.9 岁（四分位距 [IQR] 52.6–59.6）。其中，4929 人 (82%) 的 PSA <1.8 ng/ml，670 人 (11%) 的 PSA 为 1.8–<3 ng/ml（低 PSA 组，中位 PSA 2.1 ng/ml [IQR 1.9–2.5] ），377 名（6.3%）的 PSA 为 3–<10 ng/ml（高 PSA 组，中位 PSA 3.9 ng/ml [IQR 3.3–5.0]）。低 PSA 组中 7.8%、15% 和 1.0% 的男性 PI-RADS 评分为 3、4 和 5，高 P​​SA 组中男性的 PI-RADS 评分为 6.9%、17% 和 5.3%组，分别。在低 PSA 组中，有 64 名 MRI 结果呈阳性的男性（41%，95% 置信区间 [CI] 0.33-0.49）发现 PC，其中 33 名（21%）患有 Gleason 6（PC 不显着），31 名（20 %) 格里森≥7（显着 PC）。在高 PSA 组中，61 名男性中检测到 PC（56%，95% CI 0.46–0.66），其中 26 名（24%）具有 Gleason 6（不显着 PC），35 名（32%）具有 Gleason ≥7（重要的电脑）。局限性包括仅来自单轮筛选的结果。 PSA 1.8-3 ng/ml 的男性中有不可忽视的数量具有临床意义的 PC。延迟诊断这些肿瘤直至 PSA ≥3 ng/ml 是否会损害其治愈机会仍有待评估。我们研究了使用前列腺特异性抗原 (PSA) 和磁共振成像对 PSA 1.8–3 ng/ml 的男性进行筛查。我们在这些男性中发现了不可忽视的潜在有害前列腺癌数量。