When treating men with a clinical suspicion of prostate cancer, providers often turn to an ultrasound-guided biopsy of the prostate, though that method has been associated with missing clinically significant cancers and detecting clinically insignificant cancers. According to a new study published in the New England Journal of Medicine, risk assessment with MRI followed by an MRI-targeted biopsy may be superior to an ultrasound-guided biopsy for prostate cancer diagnosis.
The authors compared the two treatment options by conducting a “pragmatic, multicenter, randomized trial” they dubbed the PRECISION (Prostate Evaluation for Clinically Important Disease: Sampling Using Image Guidance or Not?) trial. The trial collected data from 25 sites in 11 countries from February 2016 to August 2017. A total of 500 study participants were involved in the trial. While 252 patients were assigned to the MRI-targeted biopsy group, the other 248 were assigned to the standard biopsy group.
Twenty-eight percent of the MRI-targeted biopsy group had a result that was not suggestive of prostate cancer. They did not undergo the biopsy. Among participants with a positive result, 29 percent had a Prostate Imaging–Reporting and Data System, version 2 (PI-RADS v2) score of 3, 40 percent had a PI-RADS v2 score of 4 and 31 percent had a PI-RADS v2 score of 5.
Clinically significant cancer was detected in 38 percent of patients in the MRI-targeted biopsy group and 26 percent of the standard-biopsy group. Also, the authors found that a median of 4 biopsy cores were obtained in the MRI-targeted biopsy group. A median of 12 cores were obtained in the standard-biopsy group.
“MRI, with or without targeted biopsy, led to fewer men undergoing biopsy, more clinically significant cancers being identified, less overdetection of clinically insignificant cancer, and fewer biopsy cores being obtained than did standard transrectal ultrasonography–guided biopsy,” wrote lead author Veeru Kasivisvanathan, MRCS, division of surgery and interventional science at University College London, and colleagues.
Another benefit of MRI, the authors added, was that one in four patients from the MRI-targeted biopsy group avoided a biopsy altogether. In addition, “participant-reported complications at 30 days” were not as frequent for patients in the MRI-targeted biopsy group, though such complications were still present.
Michael J. Barry, MD, division of general internal medicine at the Massachusetts General Hospital and Harvard Medical School in Boston, and Andrew B. Rosenkrantz, MD, department of radiology at NYU Langone Health in New York City, wrote an editorial in the same journal reflecting on the study’s findings.
“The results of the PRECISION trial represent intermediate outcomes, whereas outcomes such as prostate-cancer morbidity and mortality will take large numbers of men and many years to assess,” Barry and Rosenkrantz wrote. “Nevertheless, the findings suggest that multiparametric MRI may have a place in decisions about prostate biopsy.”