MRI-first approach could allow many to safely forego prostate biopsy
Men who opt for an MRI-first approach to prostate cancer screening can do so without added risk for three years, new data suggest.
The role of MRI in the diagnosis of prostate cancer has been rapidly growing in recent years, with numerous studies highlighting the benefits of a watch-and-wait approach based on imaging findings. Adding to that evidence is a study published recently in JAMA Oncology that indicates as many as 96% of men with positive PSA labs who show insignificant or slow-growing cancer on MRI can safely forego invasive prostate biopsy for up to three years.
“These side effects of systematic biopsies urged us to find out if MRI is reliable and safe for biopsy decision-making in men with suspected prostate cancer, and if men without abnormal MRI findings can safely skip immediate biopsy and enter clinical follow-up,” notes first author Charlie Hamm, MD, with the Department of Radiology at Charité, Berlin University Medicine in Berlin, Germany.
The team’s analysis included nearly 600 men with suspected prostate cancer, each of whom underwent multiparametric prostate MRI (mpMRI). Patients with positive MR findings were sent for prostate biopsy, while those with negative findings and who had benign biopsy results followed up for urological analyses every six months for a period of three years.
Of the 593 men, around half had negative MRI exams. Prostate biopsy was initially avoided in 44%, while 41% did not require biopsy throughout the entire three years studied. There were seven cases of clinically significant prostate cancer at the end of the three years among the men who did not undergo biopsy, though the rest were not diagnosed with aggressive malignancy.
“That means the cancer risk is very low when MRI scans of the prostate do not show any suspicious findings,” says Hamm. “Normal MRI findings alone do not offer 100% certainty, but with regular monitoring, potential cancer can still be detected early enough. For many patients, that means they can avoid the discomfort of a biopsy at first and do not need to worry about having cancer that will remain undetected.”
Although the findings are positive for men hoping to avoid biopsy, the team cautions that two things are critical to making an MRI-first approach feasible: high quality imaging exams interpreted by skilled radiologists trained specifically on prostate MRI exams, and a safety net for patients who opt out of immediate biopsy following positive PSA results.
“That means clear guidelines for PSA testing, follow-up MRIs, and criteria for when a biopsy might be needed later on,” Hamm says.
The study abstract is available here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.