According to research now published in JAMA Oncology, magnetic resonance imaging (MRI) with targeted biopsy (MRI-targeted biopsy) was shown to be just as effective at detecting prostate cancer compared with systematic 12-core transrectal ultrasonography (TRUS) biopsy.
For this multicenter, prospective, randomized study, led by Laurence Klotz, MD, FRCSC, affiliate scientist at Sunnybrook Health Sciences Centre of the University of Toronto, 453 biopsy-naive patients with clinically suspected prostate cancer who had been advised to undergo a prostate biopsy were enrolled. Clinical suspicion is defined as having a 5% or greater chance of grade group 2 (GG2) or greater prostate cancer. Patients were randomized to undergo either TRUS biopsy or MRI-targeted biopsy.
Total lesions with a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 or greater were found in 62.4% of men who underwent MRI. Maximum PI-RADS scores of 3 were found in 12.1% of patients, maximum scores of 4 in 38.1%, and maximum scores of 5 in 14.0%. Prostate cancer of GG2 and greater was detected in 30% of men who underwent TRUS biopsy, compared with 35% who underwent MRI-targeted biopsy. Thirty-seven percent of men who underwent MRI-targeted biopsy had a negative MRI result and avoided biopsy. Side effects, which were more common in the TRUS biopsy group versus the MRI-targeted biopsy group, included erectile dysfunction (4% vs 4%), hematochezia (16% vs 10%), hematospermia (42% vs 22%), hematuria (48% vs 19%), pain (32% vs 15%), prostatitis (4% vs <1%), and urinary incontinence (5% vs 2%).
"The intervention of MRI followed by MRI-guided biopsy in men at risk of prostate cancer results in similar detection rates of clinically significant prostate cancer in the intention-to-treat population compared with systematic biopsy in all men while avoiding biopsy in more than one-third of men and reducing the diagnosis of clinically insignificant cancer," conclude Dr. Klotz and colleagues. "This strategy offers substantial advantages over an initial systematic biopsy."
For More Information
Klotz L, Chin J, Black PC, et al (2021). Comparison of multiparametric magnetic resonance imaging–targeted biopsy with systematic transrectal ultrasonography biopsy for biopsy-naive men at risk for prostate cancer. JAMA Oncol. [Epub ahead of print] DOI:10.1001/jamaoncol.2020.7589
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