MRI-Guided Prostate Biopsy Improves Precision Diagnosis of Cancer

MedicalResearch.com Interview with:

Veeru Kasivisvanathan MBBS BSc MRCS MSc PGCert Lead for CPD, Division of Surgery and Interventional Science, UCL Academic Section Committee, British Association of Urological Surgeons Twitter: @veerukasi PRECISION Study Coordinator https://clinicaltrials.gov/ct2/show/NCT02380027  

Dr. Kasivisvanathan

Veeru Kasivisvanathan MBBS BSc MRCS MSc PGCert
Lead for CPD, Division of Surgery and Interventional Science, UCL
Academic Section Committee, British Association of Urological Surgeons
Twitter: @veerukasi
PRECISION Study Coordinator
https://clinicaltrials.gov/ct2/show/NCT02380027  

MedicalResearch.com: What is the background for this study? What are the main findings? 

  • We knew that there were limitations in the standard of care pathway for the diagnosis of prostate cancer, TRUS biopsy which missed harmful cancers and over diagnosed harmless cancers.
  • Emerging reports in the literature showed that using an alternative diagnostic pathway, MRI and MRI-targeted biopsy, showed promising prostate cancer detection rates
  • In 2012 we set out in an international working group to design a study that could change clinical practice and replace the standard of care with a pathway involving MRI 

 MedicalResearch.com:  Can you explain the methodology used in your paper? Why did you decide to adopt this approach?

  • PRECISION was a pragmatic randomised controlled trial carried out in 500 patients from 23 recruiting centres in 11 countries.
  • A randomised controlled trial is the highest level of evidence from a study so would be able to generate evidence that could change practical
  • The multi-centre nature of the study meant that the results were more generalisable to other settings.
  • The pragmatic nature of the study referred to the fact that a range of different types of biopsy approaches were allowed (transrectal / transperineal / visual registration / software assisted biopsy) – this makes the results more generalizable.

MedicalResearch.com: What should readers take away from your report?

  • 28% of men in the MRI arm avoided biopsy
  • The MRI arm detected 12% more men with clinically significant cancers than TRUS biopsy
  • The MRI arm detected 13% fewer men with clinically insignificant cancers than TRUS biopsy 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

  • This provides evidence replacing the standard of care TRUS biopsy pathway with a pathway involving MRI before biopsy
  • Clinicians should be educated on Prostate MRI in order to produce high quality MRI that is reported accurately
  • Increased capacity for MRI should be made available if this pathway is to be adopted 

Citations:

MRI-Targeted versus Transrectal Ultrasound Biopsy for Prostate Cancer Diagnosis

Veeru Kasivisvanathan, M.R.C.S., Antti S. Rannikko, Ph.D., Marcelo Borghi, M.D., Valeria Panebianco, M.D., Lance A. Mynderse, M.D., Markku H. Vaarala, Ph.D., Alberto Briganti, Ph.D., Lars Budäus, M.D., Giles Hellawell, F.R.C.S.(Urol.), Richard G. Hindley, F.R.C.S.(Urol.), Monique J. Roobol, Ph.D., Scott Eggener, M.D., et al.,  for the PRECISION Study Group Collaborators

http://www.nejm.org/doi/full/10.1056/NEJMoa1801993

March 19, 2018
DOI: 10.1056/NEJMoa1801993 

 

 

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