Multiparametric MRI (mpMRI) scans and targeted biopsies can improve the detection of clinically significant prostate cancer, according to new research published in JAMA Network Open.
“Distinguishing high-risk from low-risk prostate cancer remains difficult, leading to overdiagnosis and, for some men, unnecessary invasive treatments and treatment-associated morbidity,” wrote Martha M. C. Elwenspoek, PhD, University of Bristol in the UK, and colleagues. “There is, therefore, an unmet clinical need to develop tests that can detect clinically significant prostate cancer while reducing overdiagnosis of low-risk disease.”
Elwenspoek et al. aimed to compare the performance of systematic transrectal ultrasound-guided prostate biopsy, a common method for diagnosing prostate cancer, with mpMRI and a targeted biopsy. In instances when the mpMRI findings were negative, no targeted biopsy was necessary at all.
The team explored data from seven different clinics for its analysis. Overall, the combination of mpMRI and, when needed, targeted biopsy was associated with a significant improvement (57%) in the detection of clinically significant prostate cancer. In addition, mpMRI resulted in a 33% potential reduction in biopsies and a 77% reduction in the number of biopsy cores per procedure.
Limiting unnecessary biopsies, the authors explained, can reduce the likelihood of adverse effects such as “bleeding, sepsis and, rarely, death.” The reduction in biopsy cores can also help reduce the likelihood of adverse effects while also making the procedure take less time.
“This systematic review and meta-analysis suggests that introducing prebiopsy mpMRI followed by a targeted biopsy into a prostate cancer detection pathway may lead to the performance of fewer biopsies than a pathway using systematic biopsy alone,” the authors wrote. “Such an approach may increase the likelihood of detecting clinically significant prostate cancer, while reducing the detection of low-risk tumors. Introducing prebiopsy MRI, therefore, has the potential to transform practice.”