Prebiopsy MRI can ‘transform’ prostate cancer care, study finds

Prebiopsy multiparametric MRI (mpMRI) paired with targeted biopsy can improve the detection of clinically significant prostate cancer, according to a study published in JAMA Network Open.

Identifying high-risk from low-risk prostate cancers can spare men from unnecessary invasive treatments and treatment-associated morbidity, wrote first author Martha M. C. Elwenspoek, PhD, but doing so remains difficult.

“There is, therefore, an unmet clinical need to develop tests that can detect clinically significant PCa (csPCa) while reducing overdiagnosis of low-risk disease,” Elwenspoek, with the University of Bristol in the UK, and colleagues noted.

For their study, Elwenspoek et al. compared prebiopsy MRI and targeted biopsy against transrectal ultrasonography-guided systematic (TRUS) biopsy. While TRUS is commonly used to diagnose prostate cancer, it can lead to a misclassification or underdiagnosis of the disease, the authors wrote.

The team examined data from 2,582 patients taken from seven “high-quality” trials for their study. Results showed that MRI, with or without targeted biopsy, was associated with a 57% improvement in the detection of clinically significant prostate cancer when compared to TRUS biopsy. That would result in 33% fewer biopsies and 77% fewer cores taken per procedure.

“This observation adds to the evidence suggesting that the incorporation of prebiopsy MRI should be recommended for diagnostic pathways for suspected PCa,” the researchers wrote. “Introducing prebiopsy MRI…has the potential to transform practice.”

Elwenspoek and colleagues dedicated a lengthy section of their study to limitations which included potential cost concerns related to MRI and the need to properly train radiographers to perform quality mpMRI scans.

However, these concerns are outweighed by the potential to dramatically improve prostate cancer care, wrote Peter C. Albertsen, MD, MS, with University of Connecticut Health Center, in an invited commentary.

“The public health crisis of prostate cancer overdiagnosis demands a change in the current PSA screening and biopsy treatment paradigm,” Albertsen wrote. “The systematic review and meta-analysis by Elwenspoek et al offers strong support for an alternative approach that calls for a prebiopsy MRI.”