I’ve said it before, and I’ll undoubtedly say it again: multiparametric MRI (mpMRI) can avoid unnecessary biopsies. In a previous blog, “A PROMIS is a Promise for Multiparametric MRI,” I cited the results of the PROMIS study in which 576 men initially had an mpMRI scan, then underwent 2 types of needle biopsy (ouch!) so their scan results could be compared with tissue analysis. As the authors wrote, “Using MP-MRI to triage men might allow 27% of patients to avoid a primary biopsy…”^[i]

Until fairly recently, a biopsy was the next step for a man whose PSA blood test appeared suspicious for prostate cancer (PCa). The PROMIS study showed that nearly a third of such men could be spared that procedure if a noninvasive mpMRI did not reveal significant PCa. Given that over a million biopsies are performed each year in the U.S., that’s a LOT of men who can safely hold off on a biopsy. From the perspective of doctors, that means fewer patients with side effects (pain, infection, blood in semen, erectile dysfunction, etc.) From the viewpoint of insurers, we’re talking big savings in health care dollars.

But what about from the viewpoint of patients? After all, it’s their bodies, so they make up the best jury. What’s their verdict?

A study to gain the patient perspective

To find out, a team of researchers from Michigan Medicine and the University of Wisconsin turned to prostate cancer patients who were on Active Surveillance (AS). The team, under lead author Dr. Prasad Shankar, began with the premise that for purposes of monitoring during AS, the diagnostic benefits of mpMRI and needle biopsy were similar. (There are, of course, those who would argue that biopsy is better for this purpose, but an increasing number of studies like PROMIS are demonstrating otherwise.)

Dr. Shankar’s team developed testing-related quality of life survey to be administered by phone. Questions covered areas such as pain, fear and anxiety before, during and after a procedure. The researchers then recruited 122 patients with Gleason 6 PCa who were on AS, and either having prostate mpMRI or transrectal biopsy to test for disease progression. From this group, 110 men completed the survey within 72 hours after testing (55 in the mpMRI arm, and 55 in the biopsy arm). The survey generated patient-reported outcomes data which was then analyzed to compare the two arms.

Study results

It should come as no surprise that the men who had mpMRI scans “…felt better about their experience than those who underwent transrectal biopsy…”^[ii] In fact, the Shankar, et al. paper tells us, “The temporary quality-of-life [negative] impact of transrectal biopsy was significantly greater than that of prostate mpMRI.”^[iii]

For patients who have a choice, the preference for mpMRI over needle biopsy is a no-brainer. The work of the Shankar team has done men a big favor, especially in these days of patient-driven medicine. For men at risk of early stage, low risk PCa—or for those already diagnosed with low grade PCa—understanding their options empowers them for meaningful doctor-patient discussions.

Today’s patients are more self-aware and self-educated than ever before. At the same time, imaging technology in the form of noninvasive mpMRI educates both doctor and patient on what’s going on in an individual’s body before there’s any mention of biopsy needles. mpMRI is not only kinder on a man’s body and psyche, it offers the same or better diagnostic benefits as a transrectal biopsy.

To paraphrase an old saying, a picture is worth a thousand biopsy needles. A thousand, and so many more, will be spared as prostate cancer patients make their preferences known.

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] Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017 Feb 25:389)1007):815-822. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2816%2932401-1
[ii] Forrest, Wayne. “Prostate Cancer Patients Prefer mpMRI Over Biopsy.” AuntMinnie.com, Oct. 4, 2019.
[iii] Shankar PR, Maturen KE, George AK, et al. Temporary Health Impact of Prostate MRI and Transrectal Prostate Biopsy in Active Surveillance Prostate Cancer Patients. J Am Coll Radiol. 2019;16(10):1385-1392.