Initial Systematic Biopsy Versus MRI for Detection of Clinically Significant Prostate Cancer
Posted: Tuesday, March 30, 2021
Systematic 12-core transrectal ultrasonography biopsy and multiparametric MRI with selected targeted biopsy seemed to detect clinically significant prostate cancer at similar rates, according to Masoom A. Haider, MD, of the University of Toronto, and colleagues. The results of this multicenter phase III trial were published in JAMA Oncology.
“MRI with targeted biopsy is an appealing alternative to systematic 12-core transrectal ultrasonography biopsy for prostate cancer diagnosis, but [it] has yet to be widely adopted,” the investigators remarked. “MRI with targeted biopsy alone…avoided biopsy in more than one-third of men and reduced the diagnosis of clinically insignificant cancer.”
Between January 2017 and November 2019, a total of 453 biopsy-naive men with a clinical suspicion of prostate cancer were randomly assigned to undergo initial systematic biopsy (49.9%) or MRI followed by a targeted biopsy (51.1%). Of them, 93% were evaluable per protocol.
Of the patients who underwent MRI, 62.4% had a lesion with a Prostate Imaging-Reporting and Data System (PI-RADS) score of 3 or higher; maximum PI-RADS scores of 3, 4, and 5 were observed in 12.1%, 38.1%, and 14.0% of this population, respectively. A total of 37% of patients who underwent MRI had a negative result and avoided biopsy. Cancers of International Society of Urological Pathology grade group 2 or higher were identified in 30% of patients who underwent initial systematic biopsy and in 35% of those who underwent MRI with targeted biopsy. According to the investigators, adverse events seemed to occur more frequently with initial systematic biopsy. The rate of grade group 1 cancer detection was reduced by more than 50% in patients who underwent MRI.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
