I recently posted a summary of an Italian study showing that MRI (mpMRI) was superior to other prostate cancer tests in terms of predicting the need for a repeat biopsy after a previously negative result. mpMRI is able to show if there is a need for another biopsy. This is happy news for patients, who dread having to go through one or more repeat biopsies because their PSA is still rising.
Thanks to a team of researchers from Australia and the U.S. the news gets even better. The Journal of Urology has accepted their article for publication, “Multi-parametric magnetic resonance imaging guiding diagnostic biopsy detects significant prostate cancer, and could reduce unnecessary biopsies and over-detection: a prospective study.”[i]
The authors enrolled 165 men, of whom 150 completed the entire study protocol. Those patients underwent mpMRI without endorectal coil. Using a standard reporting system for evaluating prostate mpMRI (the system is called PI-RADS, and is similar to one developed for breast cancer mpMRI), two radiologists independently read and scored each patient’s images. There was substantial agreement between the readers as to the presence, location and size of suspicious areas. In order to determine how accurate the MRI results were, each patient then underwent a transperineal, grid-guided biopsy in which 30 samples were taken, as well as additional cores to areas indicated by the images. The results were very promising for mpMRI, as there was a very high degree of correspondence between the imaging and the 61% of patients whose biopsy results were positive for cancer. The accuracy of the mpMRI was greatest for men whose prostate cancer tumors proved significant, implying they would not be candidates for Active Surveillance.
The authors concluded that mpMRI can be useful in not just predicting which men should undergo a biopsy, but also identifying the specific area(s) to be biopsied. The ability to target biopsy needles to the at-risk areas means reducing the number of “blind” needles in a standard TRUS biopsy, thus taking the guesswork out of prostate biopsies. This ultimately minimizes the discomfort and risks for patients, and maximizes the accuracy of biopsy results. For doctors and patients alike, this is a winning combination.
[1] Thompson JE, Moses D, Shnier R et al. Multi-parametric magnetic resonance imaging guiding diagnostic biopsy detects significant prostate cancer, and could reduce unnecessary biopsies and over-detection: a prospective study. J Urol. 2014 Feb i. doi:10.1016/j.uro.2014.01.014. [Epub ahead of print-
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
