MRI examination optimizes biopsy decision for men with elevated PSA

This article is from the NEJM Journal Watch MRI Evaluation of Men with Elevated Levels of Prostate-Specific Antigen.
Comment on men with elevated prostate-specific antigen levels.
Author: Allan S.
Brett, MD in a screening study However, imaging examination reduced the rate of biopsy, but did not reduce the detection rate of clinically significant prostate cancer
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For men whose prostate cancer screening shows elevated prostate-specific antigen (PSA) levels, urologists are increasingly using magnetic resonance imaging (MRI) to guide biopsy decisions; MRI can also help target suspicious areas Biopsy
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In the Swedish trial, about 1,500 men (age range, 50 to 74 years old) with a PSA level ≥3 ng/mL on screening were randomly assigned to receive a regular random 12-needle prostate biopsy or initial MRI
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In the MRI group, MRI results showed that patients with suspected cancer received routine random biopsy and suspicious site-targeted biopsy
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The ending is as follows
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The proportion of patients in the MRI group who received biopsy was lower than that in the conventional biopsy group (36% vs.
73%)
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In the intention-to-treat analysis, the proportion of patients in the MRI group that detected clinically significant cancer (ie Gleason score ≥7) was slightly higher than that in the conventional biopsy group (21% vs.
18%)
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The proportion of patients in the MRI group that detected no clinically significant cancer (ie Gleason score ≤ 6) was lower than that in the conventional biopsy group (4% vs.
12%); the same was true for the proportion of benign biopsy results (11% vs.
43%)
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Commenting on the MRI-guided strategy has several advantages: it greatly reduces the proportion of patients undergoing biopsy without reducing the detection rate of clinically significant cancers, and it reduces the proportion of patients diagnosed with non-clinically significant cancers
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However, the specific data of this study may not have general applicability: the PSA threshold set in the inclusion criteria is low (3 ng/mL), and some patients in the two groups did not follow the randomization results
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Adding MRI to the PSA screening program may reduce the incidence of overdiagnosis, but it may not resolve the controversy about the pros and cons of prostate cancer screening
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Eklund M et al.
MRI-targeted or standard biopsy in prostate cancer screening.
N Engl J Med 2021 Jul 9; [e-pub].
(https://doi.
org/10.
1056/NEJMoa2100852) Related reading NEJM journal The NEJM Journal Watch is published by NEJM Group.
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