Screening strategies for prostate cancer in Israeli BRCA pathogenic sequence variant carriers

Men carrying germline pathogenic sequence variants (PSVs) in the BRCA1/2 (BRCA- PSV) are at an increased risk for early onset aggressive prostate cancer (PrCa). Screening strategies, including prostate MRI (pMRI), are advocated, yet their clinical utility remains uncertain. To this end we employed Decision Curve Analysis (DCA) to compare screening based on either family history of PrCa, age-stratified PSA or pMRI, assessing net benefits with the outcome of performing biopsy. Overall 148 BRCA- PSV carriers (8620 person/years) were included, of whom 80 had ≥ 2 consecutive visits. Of these – 53/80 (66.25%) underwent pMRI screening, and 11 underwent biopsy for radiologically suspicious lesion and 4 were diagnosed with PrCa. Gene-specific and age-stratified analyses were carried out to assess the preferred mode for guiding prostate biopsy. Compared with other strategies, pMRI demonstrated the highest net benefits across all threshold probabilities for the entire cohort and both ≥ 61 and 35–50 years.