From the Guidelines
Multiparametric MRI (mpMRI) can help reduce unnecessary prostate biopsies, but it should not be used as the sole criterion to decide whether to perform a biopsy, as it may miss clinically significant cancers. When considering the use of mpMRI to avoid unnecessary prostate biopsies, it is essential to weigh the potential benefits against the risks of missing significant cancers. According to a prospective study of 223 biopsy-naïve men with elevated PSA levels, not performing a biopsy in men with PI-RADS 1/2 lesions on MRI would have reduced the number of men requiring biopsy by 36%, reduced the identification of low-risk prostate cancer by 87%, and increased the yield of intermediate/high-risk tumors by 18%, but would have missed 15 intermediate/high-risk tumors (6.7% of study population) 1. The goals of using MRI to inform the decision of whether to perform a biopsy include reducing the number of men undergoing biopsy, reducing the detection of indolent disease, and improving the detection of clinically significant disease through targeted biopsies. Some key points to consider when evaluating the use of mpMRI in this context include:
- The potential to reduce unnecessary biopsies by approximately 25-30% in men with elevated PSA levels but no definitive evidence of cancer 1
- The importance of not relying solely on MRI results to decide whether to perform a biopsy, as this may lead to missed diagnoses of clinically significant cancers
- The need for further research to fully understand the role of mpMRI in reducing unnecessary prostate biopsies and improving patient outcomes. In clinical practice, the decision to use mpMRI should be made on a case-by-case basis, taking into account individual patient factors such as PSA level, digital rectal exam findings, and family history. Ultimately, the use of mpMRI should be considered as part of a comprehensive approach to prostate cancer diagnosis, rather than as a replacement for standard biopsy procedures.
From the Research
Multiparametric Test and Unnecessary Prostate Biopsies
- The multiparametric test has shown potential in reducing unnecessary prostate biopsies by improving the detection of clinically significant cancers and avoiding the detection of low-risk disease 2, 3, 4, 5, 6.
- Studies have demonstrated that the use of multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy can improve the detection of significant prostate cancer while limiting the detection of indolent disease 2, 3, 4, 5.
- The combination of clinical parameters and mpMRI has been shown to predict clinically relevant prostate cancer significantly better than clinical risk calculators and mpMRI alone, allowing for more accurate risk stratification and potentially reducing unnecessary biopsies 3.
- Risk-based patient selection using tools such as the Rotterdam Prostate Cancer Risk Calculator can help avoid unnecessary mpMRI scans and biopsies by identifying men with low risk of significant prostate cancer 4.
- Biparametric MRI (bpMRI) has been proposed as a rapid and simpler alternative to mpMRI, with studies showing that it can improve risk stratification and potentially avoid unnecessary biopsies 5.
- The negative and positive predictive value of MRI can be used to define the best strategy to avoid unnecessary testing and biopsies, taking into account factors such as prostate-specific antigen density, 4Kscore, and risk calculators 6.
Key Findings
- MpMRI with targeted biopsy can detect clinically significant prostate cancer with high accuracy, while avoiding the detection of low-risk disease 2, 3, 4, 5.
- The combination of clinical parameters and mpMRI can improve risk stratification and reduce unnecessary biopsies 3.
- Risk-based patient selection can help avoid unnecessary mpMRI scans and biopsies 4.
- BpMRI can improve risk stratification and potentially avoid unnecessary biopsies 5.
- The use of clinical risk screening tools in conjunction with mpMRI can help reduce unnecessary biopsies 6.