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MRI-targeted biopsy superior to standard biopsy for prostate cancer diagnosis
MRI-targeted biopsy appeared superior to transrectal ultrasonography-guided biopsy for prostate cancer detection, according to findings published in The New England Journal of Medicine.
“Multiparametric MRI, with or without targeted biopsy, is an alternative to standard transrectal ultrasonography-guided biopsy for prostate-cancer detection [among] men with a raised PSA level who have not undergone biopsy,” Veeru Kasivisvanathan, MBBS, BSc, MRCS, MSc, MRCS, MSc, NIHR doctoral fellow at University College London, and colleagues wrote. “However, comparative evidence is limited.”
Kasivisvanathan and colleagues performed a randomized noninferiority trial of 500 men with suspected prostate cancer who had not previously undergone a biopsy.
Researchers randomly assigned men to receive MRI with or without a targeted biopsy, or to undergo standard transrectal ultrasonography-guided biopsy. In the group assigned MRI, men received targeted biopsy if their results indicated prostate cancer.
The proportion of men diagnosed with clinically significant prostate cancer served as the primary outcome measure. The proportion of men diagnosed with clinically insignificant cancer served as a secondary outcome.
Seventy-one of 252 men in the MRI group had results that did not indicate prostate cancer and did not receive biopsy.
A significantly higher percentage of men who underwent MRI-targeted biopsy than standard biopsy received a diagnosis of clinically significant prostate cancer (38% vs. 26%; adjusted difference, 12 percentage points; 95% CI, 4-20).
Fewer men assigned to the MRI group received a diagnosis of clinically insignificant cancer (adjusted difference, –13 percentage points; 95% CI, –19 to –7).
“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,” Kasivisvanathan and colleagues wrote. – by Andy Polhamus
Disclosures: Kasivisvanathan reports grant support from National Institute for Health Research UK and European Association of Urology Research Foundation, as well as grant support from American Urology Association outside the submitted work. Please see the abstract for all other authors’ relevant financial disclosures.