Prostate cancer: MRI before biopsy offers better screening, according to these researchers
Conducting an MRI before the biopsy can better detect progressive cancers that need treatment, a new study shows.
Prostate cancer is cancer most common in men. It is for this reason that it is closely monitored in male patients over the age of 50. Several studies, such as the one published in The New England Journal of Medicine on December 8, show that MRI canavoid overdiagnosis.
It is estimated that 80% of prostate cancers are diagnosed at a very localized stage, as explained by Dr. Jacques Bron on his site. Of these cancers diagnosed, at least 30% have a very low risk of progressing and lead to the death of the patient. Many insignificant cancers are treated when they are harmless. New research shows that performing an MRI reduces the number of unnecessary biopsies, better target dangerous cancers and therefore improve detection.
A risk of misdiagnosis halved
The authors gathered almost 38,000 Swedes between the ages of 50 and 60. These participants performed a PSA assay, which is the prostate specific antigen. A total of 17,980 men had an elevated PSA level, which may be a sign of an abnormality in the prostate.
They were then divided into two groups. A first compound of 5,994 volunteers had to undergo the classic battery of examinations: a biopsy with several “blind” tissue samples, followed by an MRI of the prostate. If this showed suspicious results, new samples were taken from the area concerned. At the same time, the 11,986 men in the second group followed another strategy. They have first had an MRI then, if it turns out to be doubtful, a targeted biopsy.
The aim was to determine the number of clinically insignificant prostate cancer diagnoses, i.e. the amount of detection of harmless tumors.
Results: 72 of the participants in the first group received a clinically insignificant diagnosis, compared to only 66 participants in the experimental group. Knowing that this second group was more numerous, this halves the risk of incorrect screening. For Jonas Hugosson, author of the study, “This strategy significantly reduces the number of people who need to undergo tissue removal, which is an unpleasant procedure with an associated risk of infection. Additionally, the strategy halves the risk of detecting a harmless tumor, which has been the biggest obstacle to the introduction of widespread screening for prostate cancer.”
Asked by DoctissimoDr. Michael Peyromaure, head of the urology department at Cochin Hospital provides more details: “As expected, it appears that targeted biopsies after MRI significantly (about half) reduce the detection of so-called “insignificant” cancers, which may be covered bysimple monitoring. Hence the authors’ conclusion, which is logical: systematically performing an MRI and then only targeted biopsies makes it possible to limit the overdiagnosis of prostate cancer”.
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