BIOPSY FOR PROSTATE CANCER

The standard of care for diagnosing prostate cancer is set to change because of results now published from a head-to-head comparison of two different approaches.
The study, known as Prostate Evaluation for Clinically Important Disease: Sampling Using Image-Guidance or Not? (PRECISION), was conducted in 500 men for whom there was suspicion of prostate cancer, based on elevations in the levels of prostate-specific antigen (PSA) and/or abnormal results on digital rectal examination (DRE).
The results show that multiparametric MRI followed by targeted biopsy performed only on patients whose
scans were positive detected more clinically significant prostate cancer and less clinically insignificant prostate cancer than the standard approach of 10- to 12-core transrectal ultrasonography-guided biopsy (TRUS), and it did so with fewer biopsy cores.
The findings were presented here during the European Association of Urology (EAU) 2018 Congress and were simultaneously published online March 19 in the New England Journal of Medicine.
“In 2012, we set out to try and design a study in which we compared the standard of care to a pathway involving MRI so that we could change that standard of care,” lead author Veeru Kasivisvanathan, MD, University College London, United Kingdom, told delegates here.
“And we found that in biopsy-naive men with a clinical suspicion of prostate cancer, a diagnostic pathway involving prebiopsy MRI risk stratification with MRI-targeted biopsy is superior to 10- to 12-core TRUS biopsy,” he emphasized.
“In men who need to have investigation for prostate cancer for the first time, PRECISION shows that using an MRI to identify suspected cancer in the prostate and performing a prostate biopsy targeted to the MRI information leads to more cancers being diagnosed than the standard way that we have been performing prostate biopsy for the last 25 years,” he added in a statement.