MRI-directed targeted biopsy reduced prostate cancer overdiagnosis - Healio

Compared with systematic biopsy, MRI-directed targeted biopsy reduces the hazard of overdiagnosis of prostate crab for men with elevated prostate-specific antigen levels, according to researchers.

Jonas Hugosson, MD, PhD, and colleagues wrote successful The New England Journal of Medicine that “screening for prostate crab is burdened by a precocious complaint of overdiagnosis” and that “the astir due algorithm for population-based screening is unknown.”

Data derived from: Hugosson J, et al. N Engl J Med. 2022;doi:10.1056/NEJMoa2209454.

Currently, a precocious proportionality of prostate crab cases correspond small, typically harmless tumors, the researchers said successful a property release, which means that galore men could beryllium treated unnecessarily and look the hazard of imperishable complications.

“We indispensable get distant from the unsighted sampling of tissues that’s inactive modular today, trust connected the MRI examination, and frankincense power diagnostics to taking samples lone successful those men successful whom MRI has depicted tumors — and past lone bash targeted samples successful the country involved,” Hugosson said successful the release.

Hugosson and colleagues invited astir 38,000 men aged 50 to 60 years to instrumentality regular prostate-specific antigen (PSA) humor tests. A full of 17,980 (47%) participated successful the trial.

Participants who had a PSA level of 3 ng per milliliter oregon higher underwent a prostate MRI. They were past divided into 2 groups: notation and experimental.

All participants successful the notation radical who besides had elevated PSA levels underwent the modular strategy of systematic insubstantial sampling. Twelve unsighted insubstantial samples were taken from parts of the prostate, and much targeted insubstantial samples were taken if the MRI showed thing suspicious.

For participants successful the experimental group, the researchers conducted MRI-targeted biopsy and took 4 targeted samples.

Though harmful cancers were recovered connected a akin standard successful some groups, the hazard of uncovering harmless crab was halved successful the experimental group.

Of the astir 11,986 men successful the experimental group, 66, oregon 0.6%, received a diagnosis of prostate cancer. In the notation group, 72 of the 5,994 participants, oregon 1.2%, were diagnosed, “a quality of 0.7 percent points (95% CI, 1.0 to 0.4; RR, 0.46; 95% CI, 0.33 to 0.64; P < 0.001).”

For clinically important prostate cancer, the RR successful the experimental radical compared with the notation radical was 0.81 (95% CI, 0.60 to 1.1).

“The results from this survey tin pave the mode for the instauration of wide screening for prostate cancer,” Hugosson said successful the release. “But appraisal indispensable see besides different factors, specified arsenic costs and entree to MRI scans.”

The researchers noted that astir 1 successful 5 clinically important cancers were missed successful the experimental group.

They concluded that utilizing MRI-directed targeted biopsy alternatively of systematic biopsy for screening and aboriginal detection successful radical with elevated PSA levels “reduced the hazard of overdiagnosis by fractional astatine the outgo of delaying detection of intermediate-risk tumors successful a tiny proportionality of patients.”

“This strategy is sharply reducing the fig of radical who request to acquisition insubstantial sampling, which is an unpleasant process with an associated hazard of infection. What’s more, the strategy halves the hazard of detecting a harmless tumor, which has been the biggest obstacle to introducing wide screening for prostate cancer,” Hugosson said successful the release.

In an accompanying editorial, Roman Gulati, MS, of the Fred Hutchinson Cancer Research Center successful Seattle, wrote that “whether the trade-offs of omitting systematic biopsy are acceptable needs to beryllium weighed by the objective assemblage successful the discourse of modern standards of care.”

“The past of PSA screening has shown america that hard trade-offs betwixt excessively overmuch and excessively small diagnosis are inevitable,” Gulati wrote. “A reckoning is present needed with respect to whether much acceptable trade-offs tin beryllium achieved with the usage of variables that are disposable earlier diagnosis, specified arsenic triage investigating oregon MRI-targeted biopsy, oregon aft diagnosis, specified arsenic relabeling clinically insignificant prostate crab oregon utilizing due blimpish management.”

References:

• Gulati R, et al. N Engl J Med. 2022;doi:10.1056/NEJMe2214658.
• Hugosson J, et al. N Engl J Med. 2022;doi:10.1056/NEJMoa2209454.
• New prostate crab diagnostic pathway paves mode for wide screening. https://www.eurekalert.org/news-releases/973800. Published Dec. 7, 2022. Accessed Dec. 9, 2022.