medwireNews: Prebiopsy multiparametric magnetic resonance imaging (MRI) plus targeted biopsy is associated with increased detection of clinically significant prostate cancer versus ultrasonography-guided systematic biopsy alone, study data show.
The systematic review and meta-analysis of seven randomized controlled trials involving 2582 biopsy-naïve men with a clinical suspicion of prostate cancer also found that prebiopsy MRI was associated with fewer cores taken per procedure, a potential reduction in unnecessary biopsies, and a lower rate of adverse effects.
Martha Elwenspoek (University of Bristol, UK) and co-investigators therefore believe that the “evidence supports implementation of prebiopsy MRI into diagnostic pathways for suspected [prostate cancer].”
Overall, multiparametric MRI plus targeted biopsy improved detection of clinically significant prostate cancer by a significant 57% relative to systematic biopsy.
The researchers also calculated that if the men with negative multiparametric MRI findings had not undergone biopsy, a theoretical 33% overall would have avoided the procedure, with the estimates ranging from 23% to 55% depending on the trial.
Furthermore, the median number of cores taken per procedure was theoretically reduced by 77% in the targeted versus systematic biopsy groups. The median number of cores taken ranged from one to six in the former group and from 11 to 12 in the latter.
By contrast, there was no significant improvement in prostate cancer detection when MRI was followed by both targeted and systematic biopsy compared with systematic biopsy alone.
The team also found in one study that biparametric MRI, rather than multiparametric MRI, followed by targeted biopsy did not improve prostate cancer detection relative to systematic biopsy.
Only one trial reported adverse event data for the two techniques separately. In this trial, targeted biopsy was associated with lower rates of bleeding and pain at the site of the procedure compared with systematic biopsy.
Writing in JAMA Network Open, Elwenspoek and co-authors note that the definition of clinically significant prostate cancer varied among the trials, meaning their findings “should be interpreted with some caution.”
Nonetheless, they conclude: “The availability of [multiparametric] MRI and radiologists and urologists trained to use it appear to be the only hurdles to overcome in establishing [multiparametric] MRI and targeted biopsy with standardized reporting as the recommended diagnostic pathway for men with suspected [prostate cancer].”
In an accompanying commentary, Peter Albertsen from the University of Connecticut Health Center in Farmington, USA says: “The public health crisis of prostate cancer overdiagnosis demands a change in the current [prostate specific antigen] screening and biopsy treatment paradigm.”
The current meta-analysis therefore “offers strong support for an alternative approach that calls for a prebiopsy MRI,” he adds.
And although Albertsen acknowledges that “[t]his new approach raises important questions,” such as what are the best MRI sequences and biopsy approaches to use, he concludes that, overall, the analysis “provides an excellent summary and discussion of the next step in the continually evolving paradigm of prostate cancer screening.”
By Laura Cowen
medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group
JAMA Netw Open 2019; 2: e198427
JAMA Netw Open 2019; 2: e198392