Targeted biopsy with MRI reduced overdiagnosis of prostate cancer

Targeted biopsy with MRI reduces the risk of prostate cancer overdiagnosis in men with elevated levels of prostate-specific antigen compared with systematic biopsy, researchers say.

Jonas Hugoson, MD, PhD, a colleague wrote New England Journal of Medicine “Prostate cancer screening is burdened by high rates of overdiagnosis,” and “the best algorithm for population-based screening is unknown.”

Currently, the majority of prostate cancer cases are small, usually harmless tumors, researchers said in a press release.This means many men are treated unnecessarily and may face the risk of permanent complications.

“Even today, we need to move away from standard blind sampling of tissue and rely on MRI examinations. Therefore, we have switched diagnostics to take samples only from men with MRI-visible tumors, targeting relevant areas. You should only take samples that have been squeezed,” Hugoson said in a release.

Hugosson and colleagues invited approximately 38,000 men between the ages of 50 and 60 to undergo routine prostate-specific antigen (PSA) blood tests. A total of 17,980 (47%) participated in the study.

Participants with PSA levels ≥3 ng/mL underwent prostate MRI. They were then divided into her two groups, a reference group and an group.

All participants in the reference group with elevated PSA levels underwent a standard strategy of systematic tissue sampling. Twelve blind tissue samples were taken from portions of the prostate, and more targeted tissue samples were taken if MRI showed anything suspicious.

For participants in the group, researchers performed MRI targeted biopsies and collected four targeted samples.

Harmful cancers were found on a similar scale in both groups, but the risk of finding harmless cancers was halved in the group.

Of the nearly 11,986 men in the group, 66, or 0.6%, were diagnosed with prostate cancer. In the reference group, 72 of 5,994 participants, or 1.2%, were diagnosed, with a difference of 0.7 percentage points (95% CI, 1.0 to 0.4; RR, 0.46; 95% CI, 0.33 to 0.64; P. < 0.001)”

For clinically significant prostate cancer, the RR in the group compared with the control group was 0.81 (95% CI, 0.60 to 1.1).

“The results of this study could pave the way for the introduction of general screening for prostate cancer,” Hugosson said in a release. “But the evaluation should also include other factors, such as cost and access to MRI scans.”

The researchers noted that about one-fifth of clinically significant cancers were missed in the group.

They found that using targeted biopsy with MRI instead of systematic biopsy for screening and early detection of people with high PSA levels “at the cost of delayed detection of intermediate-risk tumors in a minority of patients.” paid and halved the risk of overdiagnosis.” ”

“This strategy has significantly reduced the number of people who need to undergo tissue sampling, an uncomfortable procedure that carries the risk of infection. In addition, this strategy introduces general screening for prostate cancer. It halves the risk of detecting innocuous tumors, which are the biggest obstacles to detection,” Hugosson said in a release.

In the accompanying editorial, Roman Grati, MS, A professor at the Fred Hutchinson Cancer Research Center in Seattle wrote, “Whether the trade-off of omitting a systematic biopsy is acceptable needs to be considered by the clinical community in the context of the modern standard of care.” I’m here.

“The history of PSA screening shows that difficult trade-offs between too many and too few diagnoses are inevitable,” Gulati wrote. whether a more acceptable trade-off can be achieved using variables available prior to diagnosis or using variables available post-diagnosis, such as relabeling of clinically insignificant prostate cancer. Calculations required, or use proper maintenance.”

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