A Magnetic Resonance Imaging (MRI)-targeted biopsy strategy results in fewer men needing biopsy, fewer biopsy cores required and more men with clinically significant cancer detected compared to standard transrectal ultrasound guided (TRUS) biopsy, according to the large international multicentre PRECISION study.
The much-awaited results of PRECISION also imply that traditional approaches which include 10-12 core TRUS biopsies can be avoided to minimise health risk complications for many men with suspected prostate cancer. Physicians are cautious with prostate biopsies due to the risk of infections and other complications, but without biopsies detecting aggressive prostate tumours are difficult.
“In biopsy naïve men with clinical suspicion of prostate cancer, a diagnostic pathway involving pre-biopsy MRI risk stratification and MRI-targeted biopsy is superior to 10-12 core TRUS biopsy,” said lead coordinator and author Dr. Veeru Kasivisvanathan (GB) who presented the results on behalf of chief investigators Caroline Moore, Mark Emberton (both GB) and the rest of the international study group.
He added: “MRI-targeted biopsy strategy also results in fewer men with clinically insignificant cancer detected and more favourable 30-day patient-reported complication profile.”
The randomised study which recruited 500 men allocated them into two groups, a multiparametric MRI (MPMRI) and a standard 10-12 core TRUS biopsy arm. Key eligibility criteria included a PSA < 20 ng/ml, DRE < T2, no prior biopsy and no contraindication to biopsy/MRI. In the MPMRI arm, areas of the prostate were scored on a five-point scale of suspicion for clinically significant cancer.
The outcomes showed that in detecting clinically insignificant cancer (Gleason 3+3), MRI+TB is superior to TRUS, and also in determining the proportion of cores positive for cancer. MRI + TB is also slightly better in determining maximum cancer core length over TRUS (7.8mm vs 6.5mm, respectively).
Regarding 30-day patient-reported complications, patients in the MRI arm also fared better compared to the TRUS group, with the latter reporting higher incidents of haematuria (MRI-30.2%, TRUS-62.6%), haematospermia (32.1% vs. 59.7%), and pain (12.7% vs. 23.3%), among other complaints.
Kasivisvanathan said future directions and challenges include the training of radiologists and urologists, improvements in standardization of mpMRI reporting and changes in health services increasing capacity for mpMRI.
Session chairman Prof. Peter Albers welcomed the results and said that it marks “a breakthrough” in PCa treatment.
The study involved centres in Belgium, Canada, Finland, France, Italy, Germany, the Netherlands, Sweden, United Kingdom, USA, with funding from the EAU Research Foundation, NIHR Clinical Research Network, and a UK NIHR Doctoral Research Fellowship grant for Kasivisvanathan.