Adding MRI Does Not Boost Prostate Cancer Upgrading Rate
MRI with targeted prostate biopsy plus systematic biopsy fails to improve detection of upgrading in men on active surveillance for prostate cancer vs systematic biopsy alone.
Magnetic resonance imaging (MRI) with targeted prostate biopsy added to systematic biopsy for men on active surveillance for low-risk prostate cancer (PCa) does not significantly increase the upgrading rate on confirmatory biopsy compared with systematic biopsy alone, according to a new study.
The finding is from a prospective multicenter trial in which investigators led by Laurence Klotz, MD, of Sunnybrook Health Sciences Centre in Toronto, randomly assigned 273 men diagnosed with grade group (GG) 1 PCa to undergo confirmatory 12-core systematic biopsy or MRI with targeted biopsy in addition to 12-core systematic biopsy. The primary end point was the proportion of men upgraded to GG 2 or higher cancer.
At the time of confirmatory biopsy, 23% of patients in the systematic biopsy group and 21% of those in the MRI group were upgraded to GG 2 cancer or higher, Dr Klotz and his colleagues reported online ahead of print in European Urology.
Systematic and targeted biopsies missed significant cancers in 6% and 8% of patients, respectively.
“In patients with a higher risk of significant cancer based on clinical parameters, systematic biopsy should be performed even if the MRI is negative,” the authors wrote. “Our data also suggests that high-risk patients with a positive MRI should have both systematic and targeted biopsies.”
Klotz L, Loblaw A, Sugar L, et al. Active Survival Magnetic Resonance Imaging Study (ASIST): Results of a randomized multicenter prospective trial. Eur Urol. 2018; published online ahead of print.