Multi-parametric Magnetic Resonance Imaging (MP-MRI) may be an accurate method of diagnosing clinically-significant prostate cancer that avoids complications associated with biopsy, according to a study published in The Lancet.1
Transrectal ultrasound guided biopsy (TRUS-biopsy) is frequently used after an elevated serum prostate-specific antigen (PSA), though the procedure is associated with serious adverse events including sepsis. For this study (ClinicalTrials.gov Identifier: NCT01292291), researchers assessed whether MP-MRI would be an effective component of a “triage” diagnostic procedure, using template prostate mapping biopsy (TPM-biopsy) as a reference.
Of 740 enrolled participants with an elevated PSA within the previous 3 months, a “suspicious” digital rectal or rectal examination, or a family history of prostate cancer, 576 underwent the diagnostic “triage” of MP-MRI followed by TRUS-biopsy and TPM-biopsy.
MP-MRI had a sensitivity of 93% and a negative predictive value of 89% for clinically-significant cancer: of 158 participants who had a negative MP-MRI, 17 had clinically significant cancer. TRUS-biopsy had only 48% sensitivity and a 74% negative predictive value.
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The authors concluded that MP-MRI may reduce unnecessary biopsies by 27%, as well as avoid 5% of insignificant cases of prostate cancer. Biopsies directed by MP-MRI results would improve diagnostic accuracy overall.
There were 8 cases of sepsis and 44 total cases of serious adverse events among the initially-enrolled 740 participants.
- Ahmed HU, Bosaily AE, Brown LC, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. 2017 Jan 19. doi: 10.1016/S0140-6736(16)32401-1 [Epub ahead of print]