In 1957 when Ford released the Edsel, it was hot stuff! Then, after all the hyped-up rush to dealerships, its failure to sell has become legendary. The 1950s were a boom time for cars in America, but customers shunned this new model. In addition to an unappealing design (e.g., the vertical front grille was likened to a horse collar), it was perceived as unreliable and of substandard quality. A 2010 article in the Journal of Popular Culture summed it up in eight words: “Edsel failed because consumers did not buy it.”

No one could have been more surprised than Ford executives. They had poured millions into market research when the competition among Detroit’s car manufacturers crested during the post-WWII boom. They thought the Edsel would hit the nail on the head as the automotive age blossomed. However, no sooner was it launched than a recession hit and all of the Big Three companies took a huge hit in sales of full-size cars. Instead of trading in for newer cars, owners held on to their current cars longer. By the time the economy picked up, new models from Europe were entering the country, younger car buyers were attracted to sporty cars like the Corvette and the Thunderbird, engineering had advanced, and two-car families were opting for smaller second cars. The Big Three companies took a hit, and the Edsel had been replaced. It simply faded away.

Conventional prostate detection – an Edsel?

The world of urology had established the method for early detection and diagnosis of prostate cancer (PCa):

• First, get an annual PSA blood test
• Second, if the result is abnormally high or rising, do a repeat PSA
• Third, if it’s still high or rising, have a systematic TRUS (transrectal ultrasound) biopsy. How many needles are used? In the 1990s, the typical biopsy used six (called “sextant biopsy”), but nowadays even 12 is considered barely accurate, so it’s not unusual to take 14+ samples.
• Finally, if the biopsy is positive, discuss next steps (surveillance or treatment) with your doctor.

This has been the standard PSA-and-systematic-biopsy pathway. Like the Edsel, we now realize it’s unreliable. Compared to a new alternative, it’s of substandard quality because it leads to harming patients by over-detecting insignificant PCa, missing significant PCa, unnecessary biopsies, and overtreatment with side effect risks. When first introduced, it was hot stuff. Now, consumers (patients) are not so ready to buy it.

In fact, the latest research suggests it’s time for that pathway to fade away—like the Edsel. For instance, a June 2024 paper published in the peer-reviewed Journal of the American Medical Association (JAMA) describes a superior pathway that incorporates sequential MRI as a screening tool following a suspicious PSA. Its 18 contributing authors (urologists and radiologists) hail from authoritative academic/research centers around the globe, including the U.S.

Their finding is based on a thorough investigation and analysis of 20 published studies. These included men either in the general population or who had genetic PCa risk factors. Since they all had PSA screening tests, they were grouped by those who also had MRI as part of the screening, and those who had not. In particular, the authors analyzed collective data on over 57,000 men who had PSA followed by MRI as part of sequential screening. To the best of their knowledge, it was the first such analysis to evaluate the contribution of MRI when combined with PSA screening.

Their main goal was a comparison of the rate of detecting “…clinically significant PCa defined as an International Society of Urological Pathology (ISUP) grade of 2 or higher…” while secondary objectives were the detection rate of “… insignificant PCa (defined as ISUP grade 1), positive predictive values (PPVs) for detecting significant and insignificant PCas, MRI and biopsy indication, biopsy adherence, and complication rates.”^[i]

Findings and conclusion

The authors discovered that incorporating MRI in sequence with PSA did at least as well as PSA-and-systematic-biopsy pathways when it comes to detecting clinically significant PCa while at the same time reducing the rate of picking up insignificant tumors. Just as important, if not more so, it was “… associated with a substantially reduced number of unnecessary prostate biopsies…” with better positive predictive value than standard systematic biopsies.^[ii] They concluded that since integrating MRI into the screening pathway lowers the rate of overdiagnosis of insignificant PCa and the number of unnecessary biopsies while maintaining detection of significant disease, it balances out the harms of standard screening.

In short, this and other papers encourage the integration of MRI as a replacement for the old PSA-and-systematic-biopsy method. We can all bid farewell to the Edsel of PCa detection as it fades away.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Fazekas T, Shim SR, Basile G, Baboudjian M et al. Magnetic Resonance Imaging in Prostate Cancer Screening: A Systematic Review and Meta-Analysis. JAMA Oncol. 2024 Jun 1;10(6):745-754.
[ii] Ibid.