It is always gratifying for a doctor when something he or she wholeheartedly believes in gets affirmed by published research. For me, this is the case with a new Italian study, “The Roles of Multiparametric MRI, PCA3, and PHI: Which Is The Best Predictor of Prostate Cancer After a Negative Biopsy?”[i] The authors recognize the problem patients face after a negative biopsy, but continued PSA elevation may still indicate the presence of prostate cancer. We all know that patients dread the prospect of having another biopsy, or even more should a repeat procedure also turn out negative. Thus, the authors wanted to compare which would best predict the REAL need for a repeat biopsy: PCA3 urine test, Prostate Health Index (PHI) blood test, multiparametric MRI (mp-MRI), or different combinations of these assessments.
The study recruited 170 men whose first biopsy was negative for cancer. They then participated in measurements of total and free PSA, and the PHI, PCA3 and mp-MRI prior to a standard TRUS repeat biopsy. The results were submitted for sophisticated statistical analysis. I was not surprised at the results. In two different statistical models, the authors identified mp-MRI as “the most significant contribution” and “only mp-MRI was a significant independent predictor” of cancer diagnosis on the repeat biopsy. They conclude that mp-MRI provided “the most significant improvement in the net benefit.”
It is reassuring to know that at our center, we offer patients the most advantageous approach to prostate cancer detection and diagnosis, thanks to our 3T mp-MRI. An additional benefit is our MRI-guided biopsy, which is much less invasive and offers more accurate diagnosis than the conventional TRUS biopsy. I appreciate the work of my Italian colleagues in adding to the scientific information about ways that mp-MRI excels.
[i] Porpiglia R, Russo F, Manfredi M et al. The roles of multiparametric MRI, PCA3, and PHI: which is the best predictor of prostate cancer after a negative biopsy? Results of a prospective study. J Urol. 2014 Feb 8. doi: 10.1016/j.juro.2014.01.030. [Epub ahead of print]