Benefits of Multiparametric Magnetic Resonance Imaging in Clinically Significant Prostate Cancer
In the UK PROMIS study reported in The Lancet, Ahmed et al found that use of multiparametric magnetic resonance imaging (MP-MRI) might reduce the need for transrectal ultrasound (TRUS)-guided prostate biopsy and may improve detection of clinically significant prostate cancer.
Study Details
In the study, 576 men enrolled from 11 UK sites between May 2012 and November 2015 and hadprostate-specific antigen levels ≤ 15 ng/mL and no prior biopsy. They underwent 1.5 Tesla MP-MRI followed by both TRUS biopsy and template prostate mapping (TPM) biopsy, used as the reference test. Clinically significant cancer was defined as a Gleason score ≥ 4 + 3 or a maximum cancer core length ≥ 6 mm.
Outcomes
On TPM biopsy, 408 men (71%) had prostate cancer, with cancer being clinically significant in 230 of them (40%). Sensitivity for clinically significant cancer was 93% for MP-MRI vs 48% for TRUS biopsy (P < .0001), whereas specificity was 41% vs 96% (P < .0001). Serious adverse events occurred in 44 patients (5.9%), including sepsis in 8 patients.
It was calculated that use of MP-MRI as triage might allow avoidance of primary biopsy in 27% of patients and reduce diagnosis of clinically insignificant cancers by 5%. Furthermore, it was calculated that using MP-MRI findings to determine the need for subsequent TRUS biopsy could result in detection of 18% more cases of clinically significant cancer compared with use of TRUS biopsy in all patients.
The investigators concluded: “MP-MRI, used as a triage test before first prostate biopsy, could reduce unnecessary biopsies by a quarter. MP-MRI can also reduce over-diagnosis of clinically insignificant prostate cancer and improve detection of clinically significant cancer.”
The study was funded by the UK Government Department of Health, the National Institute of Health Research-Health Technology Assessment Programme, the UCLH/UCL Biomedical Research Centre, and the Royal Marsden and Institute for Cancer Research Biomedical Research Centre.
Hashim U. Ahmed, FRCS, of the University College London, is the corresponding author of The Lancet article.
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