Posted: Wednesday, January 11, 2023
In a study published in The New England Journal of Medicine, researchers found that avoidance of systematic biopsy in favor of MRI-directed targeted biopsy for screening and early detection in persons with elevated prostate-specific antigen (PSA) levels may reduce the risk of overdiagnosis by half. Their screening algorithm included “PSA measurement followed by MRI evaluation and targeted biopsy only, as compared with systematic biopsy of all participants with elevated PSA.”
“We must get away from the blind sampling of tissues that’s still standard today, rely on the MRI examination, and thus switch diagnostics to taking samples only in those men in whom MRI has depicted tumors—and then only do targeted samples in the area involved,” commented Jonas Hugosson, MD, PhD, of the University of Gothenburg, Sweden, in a press release from the Swedish Research Council.
Dr. Hugosson and colleagues studied 37,887 men, aged 50 to 60, who were invited to take the PSA blood test. In the event of their PSA levels being elevated, they were offered an MRI of the prostate. The 17,980 men who took part were divided into two groups. A total of 66 of the 11,986 participants in the experimental group received a diagnosis of clinically insignificant prostate cancer, compared with 72 of 5,994 participants in the reference group. Clinically significant cancer that was detected by systematic biopsy alone was diagnosed in 10 participants in the reference group. All cases were of intermediate risk and involved mainly low-volume disease, which was managed with active surveillance.
“The results from this study can pave the way for the introduction of general screening for prostate cancer. But assessment must include also other factors, such as costs and access to MRI scans,” stated Dr. Hugosson.
Disclosure: For disclosure information for the study authors, visit nejm.org.