Increased detection of high-risk prostate cancer with targeted biopsy technique

1. Increased rates of high-risk prostate cancer was detected among individuals with suspected prostate cancer using a targeted technique for prostate biopsy, versus the current standard technique.

2. The targeted technique resulted in lower detection of low-risk prostate cancer than that detected using the current standard technique.

Evidence Rating Level: 2 (Good)          

Study Rundown: The standard biopsy technique currently utilized to detect prostate cancer involves random sampling of the entire organ rather than a targeted image-guided process. This study aimed to compare the efficacy of the current standard biopsy technique with the efficacy of targeted biopsy technique involving multiparametric magnetic resonance imaging (MP-MRI) and the efficacy achieved using both techniques combined. The study prospectively enrolled 1003 men who demonstrated at least one abnormal prostate lesion detected on MP-MRI following either an elevated prostate specific antigen (PSA) or abnormal prostate exam. Patient subsequently received a targeted biopsy using the MP-MRI findings and a standard biopsy performed by a physician who was blinded to the MP-MRI findings. Analysis of the collected pathological samples revealed increased detection of high-risk prostate cancer using the targeted technique, but decreased detection of low-risk prostate cancer. Minimal benefit was achieved by using both techniques together. While these promising findings indicate that targeted biopsy may improve detection of high-risk prostate cancer, this study is preliminary in nature. Additional studies are required to assess the impact of this biopsy technique on other clinical outcomes including survival prior to widespread implementation, particularly given the additional costs associated with the targeted technique.

Click to read the study, published today in JAMA

Click to read an accompanying editorial, published today in JAMA

Relevant Reading: Utility of Multiparametric Magnetic Resonance Imaging Suspicion Levels for Detecting Prostate Cancer

In-Depth [prospective cohort]: This study enrolled 1003 patients at the National Cancer Institute in Bethesda, Maryland who demonstrated at least one abnormal prostate lesion detected on MP-MRI following either an elevated prostate specific antigen (PSA) or abnormal prostate exam. All patients underwent a targeted biopsy and standard technique biopsy and pathological samples were graded for risk level using the Gleason scored. While 461 patients were diagnosed with prostate cancer using targeted biopsy and 469 patients using standard biopsy, 173 high-risk and 213 low-risk cases were diagnosed with the targeted technique versus 122 high-risk and 258 low-risk cases with the standard biopsy. This resulted in targeted technique detecting 30% more high-risk cases and 17% fewer low-risk cases than standard technique. When the pathological yield of adding a standard biopsy to targeted biopsy was assessed, it was determined that 200 additional men would have to receive both biopsies in order to detect 1 additional case of high-risk cancer.

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