MRI Screening Boosts Identification of Harmful Prostate Cancers
Initial screening with MRI also reduced the need for painful prostate biopsies.
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To diagnose prostate cancer, doctors must take biopsies of the prostate -- a procedure that can involve removing a dozen or more tissue samples using a needle inserted via the anus. Such biopsies are invasive, costly and often painful. In addition, this method samples limited regions of the prostate and may miss tumors.
Results of a new clinical trial point to a promising way to reduce the number of biopsies needed while simultaneously increasing the number of cancers correctly identified. The PRECISION trial, an international, randomized, phase 3 clinical trial, is evaluating the use of MRI scanning for diagnosis of prostate cancer. Initial results were presented at the European Association of Urology Congress in Copenhagen March 19 and simultaneously published in the New England Journal of Medicine.
The trial investigators randomized 500 men to receive either a standard biopsy or an MRI scan. Patients in whom the MRI revealed a possible tumor then received a targeted biopsy based on the location identified from the scan. The study assessed the percentage of men in each treatment arm who were diagnosed with a clinically significant cancer, meaning that it warranted treatment.
Harmful cancers were identified in a higher proportion of the men who underwent an initial MRI scan (38 percent) compared to those who received a standard biopsy (26 percent). Remarkably, this increase in diagnosis occurred despite fewer men in the MRI arm receiving a biopsy: 28 percent of the men who received an initial MRI scan did not require any biopsy at all.
Initial MRI screening increased detection of clinically significant cancers while allowing many men to avoid an invasive and costly medical procedure. While expanding the use of MRI would incur additional costs, the authors note that economic analyses have suggested that long-term savings due to improved accuracy and patient outcomes make MRI-based diagnosis more cost-effective than the current standard.
The researchers say the study is the first randomized trial showing benefits of using MRI for prostate cancer diagnosis. The investigators note that widespread adoption of MRI-based diagnosis will require better availability of high-quality MRI and additional training for clinicians.