MRI-targeted biopsy for prostate cancer diagnosis
Speaker: Veeru Kasivisvanathan
Accurate detection of clinically significant prostate cancer is vital for the most effective management of the disease. The typical approach has been to offer men with elevated prostate-specific antigen (PSA) level, or an abnormal digital rectal examination, a standard transrectal ultrasonography–guided (TRUS) biopsy of the prostate (See ESMO algorithm).
The PROMIS trial, however, revealed that this approach is not optimal for detecting clinically significant prostate cancer, and showed that multiparametric magnetic resonance imaging is an alternative approach that can reduce overdetection of clinically insignificant prostate cancer and improve detection of clinically significant cancer. In this video, study author Veeru Kasivisvanthan (Frimley Health NHS Foundation Trust, UK) describes the rationale and results of the PRECISION (Prostate Evaluation for Clinically Important Disease: Sampling Using Image Guidance or Not?) trial which tested the noninferiority of multiparametric MRI over standard TRUS biopsy, as well as providing specific advice to clinicians regarding the use of this approach.
1:13 What was the study design?
2:06 What were the results and their implications for practice?
2:32 For which patients would you recommend an MRI prior to biopsy?
3:12 Is there a PSA threshold for a biopsy?
3:53 Do you recommend doing an MRI before the first biopsy or awaiting a negative first TRUS biopsy?
4:33 Which type of MRI-targeted biopsy do you recommend?
5:07 Are there any long-term problems with using gadolinium as a contrast agent?
6:27 What future work is required in this area?