MRI-guided biopsy or not? Both beat standard invasive method for prostate cancer diagnosis
When testing for prostate cancer, multiparametric MRI with or without targeted biopsy was more effective than the common standard transrectal ultrasonography-guided biopsy, according to a study in the May 10 issue of The New England Journal of Medicine.
“MRI, with or without targeted biopsy, led to fewer men undergoing biopsy, more clinically significant cancers being identified, less over- detection of clinically insignificant cancer, and fewer biopsy cores being obtained than did standard transrectal ultrasonography–guided biopsy,” wrote corresponding author Veeru Kasivisvanathan, with University College London (UCL) and UCL Hospitals NHS Foundation Trust and colleagues.
Tradition standard transrectal ultrasonography-guided biopsy of the prostate is associated with the under detection of clinically significant prostate cancer and over detection of clinically insignificant cancer, authors noted.
The team compared the two treatments in a 25-center randomized trial termed the Prostate Evaluation for Clinically Important Disease: Sampling Using Image Guidance or Not? (PRECISION).
The study included 500 men with clinical suspicion of prostate cancer who had not undergone a previous biopsy. They were assigned either to undergo MRI with or without targeted biopsy or transrectal ultrasonography-guided biopsy.
Of the total, 28 percent had results that did not warrant a biopsy. Overall, results showed clinically significant cancer was found in 95 men (38 percent) in the MRI-targeted biopsy group compared to 64 (26 percent) in the standard-biopsy group. Authors wrote MRI, with or without targeted biopsy, was “noninferior” to standard biopsy and the MRI approach achieved an 88 percent sensitivity.
Additionally, fewer men in the MRI-targeted biopsy group received a clinically insignificant cancer diagnosis than the standard-biopsy group.
“The use of risk assessment with MRI before biopsy and MRI-targeted biopsy was superior to standard transrectal ultrasonography–guided biopsy in men at clinical risk for prostate cancer who had not undergone biopsy previously,” authors wrote.
Andrew Rosenkratz, MD, with Massachusetts General Hospital, and Michael J. Barry, MD, with NYU Langone Health, responded to this study in an editorial published online May 9 in The New England Journal of Medicine.
They argued the results of the PRECISION trial represent “intermediate” outcomes, while “outcomes such as prostate-cancer morbidity and mortality will take large numbers of men and many years to assess,” they wrote.
He cautioned the sensitivity of multiparametric MRI may be overestimated in this study because MRI-targeted biopsy was not performed separately, but suggested the method may have value in evaluating the disease subject to further testing.
“The findings suggest that multiparametric MRI may have a place in decisions about prostate biopsy,” Rosenkratz et al. wrote. “Because of the major implications for wider use of multiparametric MRI in evaluating men with elevated PSA levels—including the need for additional MRI equipment and personnel and the effect on total costs—these findings should be replicated and extended.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.