Results from a stage 3 PRECISE trial showed that MRI with targeted biopsies matched or exceeded the accuracy of the standard for the detection of clinically significant prostate cancer.
Results from Phase 3 Prostate Assessment for Clinically Important Disease: MRI test vs. Standard Assessment Methods (PRECISE) showed that MRI with targeted biopsies (MRI-TBx) matched or exceeded the accuracy of the standard for the detection of clinically significant prostate cancer.1
The current standard, ultrasound-led transrectal 12-heart systemic biopsy (TRUS) (TRUS-Bx), may lead to overdiagnosis in low-risk prostate cancer and underdiagnosis in some cases prostate cancer with higher risk.2 Repeat biopsies, recurrence of degenerative disease, and delay or misdiagnosis of clinically significant disease.
Authors of the new study, published in Oncology JAMA. Urology Pathology level 2 (GG2) group or larger prostate cancer.
The study included biopsy-naïve patients who were suspected of having prostate cancer and who were told to go through a biopsy. Criteria included:
- Clinical suspicion, defined as 5% or more chance of GG2 or higher prostate cancer using Prostate Cancer Prevention Test Risk Calculator, version 2
- Prostate specific antigen levels of 20 ng / mL or less
- Without contraindication to MRI
In a resolution population of 453 patients, 226 (49.9%) were randomized to undergo TRUS biopsy, and 227 (51.1%) underwent MRI. Of these patients, 421 (93%) were valuable. PI-RADS lesions 3 or higher were detected in 128 of the patients who underwent MRI. Of these men, 12.1% had the highest PI-RADS scores, 38.1% had 4 scores, and 12% had 5 scores.
GG2 and larger cancers were identified in 30% of patients in the TRUS-Bx group, compared with 35% in the MRI-TBx group, which the authors note the MRI-TBx arm at least matches the performance of the normal TRUS-Bx. . Adverse events were also less common in the MRI-TBx group. Negative MRI results resulted in 83 (37%) of the men in the MRI cohort avoiding biopsies altogether. Pre-diagnosis of clinically insignificant prostate cancer was also reduced in the MRI-TBx group, from 22% to 10%.
“My colleagues and I are very excited about these results which show, without a doubt, that future images and targeted biopsies are the diagnosis of prostate cancer. We can treat more of the cancers we need to treat. capture, avoid unnecessary treatment at the same time and improve the quality of life for our patients, “lead study author Laurence Klotz, MD, chair of prostate cancer study at the Sunnybrook Center for Health Sciences, said in a statement.3 “We thank the study partners and our funders for their support and look forward to continuing our efforts to make greater use of this technology. “
References
1. Klotz L, Chin J, Black PC, et al. Comparison of multiparametric magnetic imaging targeted biopsy – systemic transrectal ultrasonography targeted biopsy for biopsy-at-risk men for prostate cancer. JAMA Oncol. Published online February 4, 2021. doi: 10.1001 / jamaoncol.2020.7589
2. Churukanti G fusion biopsy, Siddiqi MM.MRI – TRUS against 12-heart systemic biopsy. Nat Rev Urol. Published online June 16, 2015. doi: 10.1038 / nrurol.2015.143