Combining MRI and blood tests to avoid unnecessary prostate biopsies

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MRI of nan prostate, mixed pinch a humor test, tin thief find if a prostate lesion is clinically important cancer, caller investigation suggests.

A caller meta-analysis by investigators from Brigham and Women's Hospital, a founding personnel of nan Mass General Brigham healthcare system, suggests that doctors and patients tin debar unnecessary prostate biopsies by combining MRI of nan prostate findings pinch prostate-specific antigen (PSA) density. This caller attack to diagnosing clinically important prostate crab tin alteration diligent harm and wellness attraction costs of prostate biopsies. Their results are published March 29 successful JAMA Network Open.

An enlarged prostate aliases imaginable prostate crab is simply a communal rumor for older men. There will beryllium astir 300,000 caller cases of prostate crab successful nan U.S. this year. But not each those cancers require curen -; aliases moreover request to beryllium biopsied.

"In nan workup of men suspected of having prostate cancer, prostate MRI findings mixed pinch PSA density measurement tin thief doctors determine which patients to biopsy," said elder writer Ramin Khorasani, MD, MPH, Radiology Vice Chair for Quality and Safety astatine Brigham and Women's Hospital and Mass General Brigham and Philip H. Cook Professor of Radiology astatine Harvard Medical School. "With this caller analysis, we looked to spot really MRI tin thief urologists determine which patients to biopsy and which patients whitethorn not request fierce test and treatment."

Researchers person known for a agelong clip that not each prostate crab is dangerous. However, telling which cancers request curen without a biopsy tin beryllium difficult. Biopsies, particularly those of nan prostate, tin beryllium uncomfortable, invasive, and expensive.

To doctors, clinically important prostate crab (csPCa) is prostate crab that has a precocious chance of threatening a patient's life. They person cells that look much aggressive, aliases crab is recovered extracurricular of nan prostate gland.

Prostate crab is nan 2nd astir communal crab successful men worldwide, but we request to beryllium capable to place patients who require prostate biopsy while avoiding unnecessary procedures and minimizing nan consequence of missing clinically important prostate cancer. These findings propose that patient-tailored prostate biopsy decisions based connected accusation from MRI and humor tests could forestall unnecessary procedures while maintaining precocious sensitivity."

Adam Kibel, MD, chair of nan Department of Urology and co-author of nan study

MRI of nan prostate tin supply immoderate of this information. Still, a biopsy is traditionally needed to find really fierce nan crab cells look. This study tested a caller approach: combining MRI-based prostate imaging reporting and information strategy (PI-RADS) scores pinch prostate-specific antigen (PSA) density to find which cancers were apt to beryllium clinically important without including accusation from a biopsy. PI-RADS scores nan prostate lesion from 1 (highly improbable to beryllium clinically significant) to 5 (cancer is highly apt to beryllium clinically significant). PSA density (PSAD) is nan PSA humor level divided by nan prostate's measurement (as wished by MRI).

The JAMA Network Open study builds upon erstwhile findings from a akin study utilizing information only obtained astatine Brigham Women's Hospital, published successful nan Journal of nan American College of Radiology successful 2022. That study recovered that an study utilizing PI-RADS and PSAD cutoffs could pinpoint up to 50% of cases successful which a biopsy would beryllium unnecessary. The caller study, whose first and 2nd authors are Arya Haj-Mirzaian, MD, MPH, and Kristine S. Burk, MD, did nan aforesaid study connected information from 72 antecedently published studies of men pinch prostate cancer, including their PI-RADS results, prostate-specific antigen density testing, and determination of objective value from a biopsy.

The meta-analysis gave them a dataset of much than 36,000 patients to find if their earlier findings astatine BWH held successful a much divers sample set. They recovered that prostate biopsies whitethorn beryllium unnecessary for patients pinch a PI-RADS nether 4 and a PSAD beneath 0.10 ng/ml2. The researchers recovered that utilizing circumstantial PI-RADS and PSAD cutoffs, doctors could confidently skip 50% of biopsies while only missing 5% of clinically important cancers, aliases they could skip 30% and only miss 3%.

"These information springiness america nan assurance to opportunity that successful immoderate cases, we tin safely travel men pinch testing alternatively than aggressively prosecute a biopsy successful each cases," Kibel said. "By making this accusation disposable to physicians and patients, we tin thief them make a much informed determination astir undergoing a biopsy."

The adjacent measurement successful this investigation is utilizing nan study to create an easy-to-use patient-level scoring strategy that urologists tin usage to measure their patient's request for a biopsy.


Journal reference:

Haj-Mirzaian, A., et al. (2024). Magnetic Resonance Imaging, Clinical, and Biopsy Findings successful Suspected Prostate Cancer: A Systematic Review and Meta-Analysis. JAMA Network Open, e244258.