Traditionally, men with a prostate-specific antigen (PSA) level high enough to raise the possibility of prostate cancer get a biopsy for a definitive diagnosis. Even if cancer is found, it may be low-grade and not require immediate treatment. Identifying low grade versus higher grade cancers without going immediately to a biopsy would be a welcome advance.
A study published online Feb. 11, 2021, by JAMA Oncology looked at using magnetic resonance imaging (MRI) of the prostate to accomplish this. Researchers compared two diagnostic strategies in men with a prostate cancer risk greater than 5%, based on a standard questionnaire and PSA level. One-half of the 435 participants underwent an ultrasound-guided 12-sample prostate biopsy. The other half had prostate MRI.
All men with an abnormal MRI received a prostate biopsy. Because the MRI showed which areas of the prostate were most suspicious for cancer, fewer than the standard 12 biopsy samples were needed. The accuracy of diagnosis for higher grade prostate cancer was similar for immediate biopsy vs. MRI first. Also, 37% of the men who had a completely normal MRI were able to avoid biopsy. These results support findings in prior studies showing that MRI may save some men with a high PSA from a biopsy and also helps identify the more aggressive types of prostate cancer that need immediate treatment.
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