Clinical trial results show MRI as more accurate and less intrusive at diagnosis for men with a clinical suspicion of prostate cancer.
Using MRI with targeted biopsies (MRI-TBx) performs equivalently in detecting clinically significant prostate cancers to the current standard of transrectal ultrasound-guided biopsies (TRUS-Bx), according to newly released research.
The findings of the PRostate Evaluation for Clinically Important Disease: MRI vs Standard Evaluation Procedures (PRECISE) study show that MRI-TBx can facilitate more accurate and less invasive prostate cancer diagnosis, said a team of researchers from Canada. They published their results in the Feb. 4 JAMA Oncology.
“My colleagues and I are thrilled about these results that show, without a doubt, that imaging and targeted biopsies are the future of prostate cancer diagnosis,” said lead study author Laurence Klotz, M.D., chair of prostate cancer research at Sunnybrook Health Sciences Center. “We can catch more of the cancers we should be treating, avoid unnecessary treatment at the same time, and improve the quality of life for our patients.”
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For this phase III randomized clinical trial, Klotz’s team enrolled 453 participants from multiple academic medical centers throughout Canada who were selected to receive either MRI imaging followed by MRI-TBx of suspicious areas or a systematic 12-core TRUS-Bx.
Based on their analysis, the team determined that MRI-TBx does a better job of pinpointing clinically significant prostate cancers, finding 5 percent more cancers than were detected by TRUS-Bx. This result, Klotz’s team said, proves MRI-TBx’s equivalent performance. The use of MRI also resulted in a 55-percent drop in the unnecessary diagnosis of slow-growing, clinically insignificant prostate cancers.
In addition, more than one-third of patients in the MRI arm of the trial were able to side-step biopsies completely after receiving negative imaging results. They underwent follow-up MRI after two years. For those men in the MRI arm who did have biopsies, fewer samples were taken than with systematic TRUS biopsy, leading to less procedure-related pain and discomfort.
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Equally as important, the team pointed out, men treated in the MRI arm experienced fewer adverse side effects, including less blood in their urine and incontinence.
These findings will result in changes to patient care, according to team members.
“The study’s findings have influenced Ontario Health-Cancer Care Ontario’s upcoming, updated Prostate MRI Guidelines, which will be released this year,” said Masoom Haider, M.D., professor of medical imaging at the University of Ontario and clinical scientist with the Ontario Institute for Cancer Research. “I am pleased to see our research produce results that will make a real difference in how prostate cancer is diagnosed and improve the lives of patients.”
However, said Olivier Rouvière, M.D., Ph.D., from the Hospices civils de Lyon, Department of Urinary and Vascular Imaging, Hôpital Édouard-Herri, in an accompanying editorial, it is important to note that these findings only show the equivalent performance of MRI-TBx – not its superiority to the current standard. Consequently, MRI will likely not be a stand-alone triage test.
“Most likely, MRI findings will be used in conjuction with other biomarkers, such as PSA density to select, among the patients with positive MRI findings, those who need targeted biopsy (and those who may safely avoid it), and among the patients with negative MRI findings, those who may still deserve systematic biopsy,” Rouvière saidi. “In addition,…quality insurance monitoring MRI interpretation and targeted biopsy and systematic biopsy execution will need to be strictly implemented at the institution level.”