Are MRI-Assisted Biopsies More Effective Than Standard Ultrasound-Guided Biopsies Alone in the Detection of Prostate Cancer?
Using magnetic resonance imaging (MRI) to target biopsies is more effective at detecting prostate cancers that are likely to need treatment than standard ultrasound-guided biopsies alone, according to research published by Elwenspoek et al in JAMA Network Open.
Prostate biopsies can cause side effects and do not always identify the severity of a cancer when it is present. MRI scans are increasingly being used before undertaking a prostate biopsy as part of the clinical pathway to diagnose prostate cancer, but their use isn’t yet widespread in many countries.
Methods
The systematic review and meta-analysis combined results from seven studies covering 2,582 patients. Data were pooled using random-effects meta-analysis. Risk of bias was assessed using the revised Cochrane tool, and Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed.
All review stages were conducted by two reviewers. Researchers compared the performance of systematic transrectal ultrasonography–guided prostate biopsy (standard biopsy) vs prebiopsy biparametric or multiparametric MRI followed by targeted biopsy with or without systematic biopsy.
Findings
The researchers found that the use of prebiopsy MRI combined with targeted prostate biopsy was associated with a 57% (95% confidence interval [CI] = 2%–141%) improvement in detection of prostate cancer than an ultrasound-guided biopsy alone. Using prebiopsy MRI led to a 77% reduction in biopsy cores being taken per procedure, which in turn reduced side effects, and may potentially lead to avoiding biopsies for some men. Additionally, the use of prebiopsy MRI was associated with a 33% potential reduction in the number of biopsy procedures.
Commentary
Study author Richard Bryant, MBChB, PhD, FRCSUrol(Ed), academic consultant urologist at the Nuffield Department of Surgical Sciences at Oxford University, said, “This research adds to the growing body of evidence that targeting biopsies through prebiopsy MRI, in men being checked for possible prostate cancer, leads to a more accurate sampling of the prostate gland. It could also potentially lead to fewer biopsies and less chance of a misleading biopsy result through better initial sampling. Whilst there are obviously benefits for men to have a prostate biopsy if indicated, so that we can diagnose and then treat clinically significant prostate cancer, if we can reduce the potential side effects and increase the accuracy of the initial biopsy procedure, then that will be better for patients.”
Martha Elwenspoek, PhD, research associate at the NIHR Collaboration for Leadership in Applied Health Research and Care West and the University of Bristol Medical School, said, “Our findings suggest that using an MRI to guide prostate biopsies is superior to performing a biopsy alone. This is increasingly used in the United Kingdom, but isn’t yet common practice in many other countries. However, our work shows that this approach is better at detecting cancer that requires treatment, while also potentially avoiding some unnecessary biopsy procedures.”
In the United Kingdom, prebiopsy MRI was recently recommended by the National Institute for Health and Care Excellence.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
