In men with prostate lesions visible on multiparametric magnetic resonance imaging (MRI), performing both MRI-targeted and systematic biopsies improves prostate cancer (PCa) diagnostic accuracy better than either method alone, according to new study results published online ahead of print in the New England Journal of Medicine.
“Potentially, these data may usher in a new era of increased confidence in the selection of prostate cancer treatment on the basis of biopsy results,” Peter A. Pinto, MD, of the National Cancer Institute, and colleagues stated
Of 2103 men (mean age 63 years) who underwent both biopsy methods in the Trio study (NCT00102544), 62.4% had PCa based on combined biopsy results. MRI-targeted biopsy detected significantly more clinically important cancers, defined as grade group 3 or higher, than 12-core systematic biopsy (8.3% vs 1.9%) and significantly fewer indolent grade group 1 cancers (3.5% vs 7.8%). MRI-targeted biopsy still missed 8.8% of important cancers, however.
In contrast, combined biopsy led to cancer diagnoses in 208 more men (9.9%) than either method alone and to upgrading in 458 men (21.8%). For the 404 men (19.2%) who underwent radical prostatectomy, the fewest upgrades to grade group 3 or higher on histopathology occurred after combined biopsy (3.5% vs 8.7% MRI-targeted vs 16.8% systematic biopsy).
“Therefore, although combined biopsy resulted in a small net increase in the diagnosis of indolent cancers, its high predictive value for a patient’s true pathological grade group reduces the likelihood of misdiagnosis and should translate into decreased diagnostic uncertainty,” Dr Pinto’s team stated. “With decreased diagnostic uncertainty, both overtreatment and undertreatment should be reduced.”
The team noted that MRI-targeted biopsies were performed right before systematic biopsies in the study. It is possible that MRI information, such as hemorrhage tracks, might have influenced the performance of systematic biopsies.
Results from the new study are consistent with findings from another recent paper published in European Urology Oncology, which attempted to find a subgroup of men for whom MRI-targeted biopsy would suffice.
“To date, we are still far from safely identifying patients who might benefit from [MRI-targeted biopsy] alone, relying on the combination of patient characteristics and [multiparametric] MRI parameters,” Paolo Dell’Oglio, of IRCCS San Raffaele Scientific Institute in Milan, Italy, and colleagues concluded. “Therefore, the combination of [MRI-targeted biopsy] and [transrectal ultrasound-guided biopsy] should strongly be considered the best available approach to reduce the risk of [clinically significant] PCa misdiagnosis and to provide the most reliable depiction of PCa multifocality,”
Ahdoot M, Wilbur AR, Reese SE, et al. MRI-Targeted, systematic, and combined biopsy for prostate cancer diagnosis. N Engl J Med. 2020;382:917-928. doi: 10.1056/NEJMoa1910038
Dell’Oglioa P, Stabilea A, Soligob M, et al. There Is No Way to Avoid Systematic Prostate Biopsies in Addition to Multiparametric Magnetic Resonance Imaging Targeted Biopsies. Eur Urol Oncol.