Using MRI before invasive biopsy effective for diagnosis of prostate cancer

A large international study has shown that an MRI scan can reduce the number of invasive prostate biopsies by up to 28%. The trial, named PRECISION, shows that using MRI to target prostate biopsies leads to more of the harmful prostate cancers, and fewer harmless cancers being diagnosed. The results are presented at the European Association of Urology Congress in Copenhagen, with simultaneous publication in the New England Journal of Medicine.

Prostate cancer is currently diagnosed by examining biopsy samples taken from the prostate via a procedure called TRUS (TRansrectal UltraSound guided prostate biopsy). This means taking around 10-12 samples from the prostate using a probe with a special needle. It is uncomfortable, costly, and carries a slight risk of infection, but because it involves estimating the position of a possible tumor, it also means that tumors are often missed.

The researchers found that 71 (28%) of the 252 men in the MRI arm of the study avoided the need for a subsequent biopsy. Of those who needed a biopsy, the researchers detected clinically significant cancer in 95 (38%) of the 252 men, compared with 64 (26%) of the 248 men who received only the TRUS biopsy.

“This shows that a diagnostic pathway with initial MRI assessment followed by biopsy when required, can not only reduce the overall number of biopsies performed but can give more accurate results than TRUS-biopsy alone. We also found that patients who had MRI had fewer side effects than those who just had the standard TRUS biopsy. This is because the MRI allows some men to avoid biopsy and in those who need one, is able to better indicate which area of the prostate needs to be investigated, so you don’t need to randomly sample the whole prostate and can use fewer biopsy cores”, said Dr Veeru Kasivisvanathan of University College London and first author of the study.

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