MedicalResearch.com Interview with:
Dr. Lars Boesen MD PhD
Department of Urology
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The current standard of care in prostate cancer diagnosis includes untargeted transrectal ultrasound-guided biopsies for all biopsy-naïve men with clinically suspicion of prostate cancer. However, this strategy that practically has remained unchanged for decades has limited diagnostic accuracy as significant cancers are missed or under-graded and insignificant cancers are unintendedly detected by the random sampling leading to possible overtreatment.
Multiparametric MRI in the diagnosis of prostate cancer has been studied extensively in recent years and has improved detection, localization, staging and risk stratification. It has been suggested that if multiparametric MRIs were used as a triage test prior to biopsies, a significant proportion of men might safely avoid prostate biopsies and the diagnostic ratio of significant vs. insignificant cancer could be improved compared to performing standard biopsies in all men. However, multiparametric MRIs are generally time-consuming (~40 min scan time), expensive and include intravenous contrast media. This reduces its feasibility for widespread clinical implementation in larger patient populations in the western community with its high PCa prevalence.
The development of a simpler and faster (~15 min) biparametric MRI protocol using less scan sequences and circumvents intravenous contrast-media seems to preserve adequate diagnostic accuracy in a detection setting and could facilitate dissemination of prostate MRI as a triage test before any biopsy.
Here we present a large prospective study that assesses the diagnostic accuracy of a novel biparametric MRI to rule out significant prostate cancer in N=1020 biopsy-naive men with clinically suspicion of prostate cancer.
We found that a low suspicion biparametric MRI had a very high negative predictive value (97%) for ruling out significant cancer on confirmatory biopsies. Furthermore, bpMRI suspicion scores were strongly associated with prostate cancer detection rates and restricting biopsies (targeted plus standard) to men with suspicious biparametric MRIs meant 30% could avoid prostate biopsies, improved significant prostate cancer diagnosis by 11%, and reduced insignificant prostate cancer diagnosis by 40% compared to our current diagnostic approach – standard biopsies for all men with clinically suspicion of prostate cancer.
MedicalResearch.com: What should readers take away from your report?
Response: Our results suggest that a simple and rapid bpMRI can be used as a triage test to improve prostate cancer risk stratification prior to biopsies and may be used to exclude aggressive disease and avoid unnecessary biopsies with its inherent risks. This less expensive biparametric MRI approach could facilitate dissemination of prostate MRI as a triage test in a larger scale compared to multiparametric MRI.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We are aware that this is a novel technique and further studies are needed to validate our single center findings and fully explore its role in prostate cancer management before a widespread implementation into clinical practice. Furthermore, as we included patients from a non-PSA-screened population, the diagnostic accuracy of biparametric MRIs might be different in other patient populations. Furthermore, we must explore the long-term health outcomes of these study patients including a cost-benefit analyses of this diagnostic approach in the future.
MedicalResearch.com: Is there anything else you would like to add?
Response: There is no doubt that the result of this study is will change our current practice towards offering all men with clinically suspicion of prostate cancer a biparametric MRI prior to biopsies in the future. As a result, we hope to avoid many unnecessary biopsies and overdiagnosis of men with insignificant disease that can be managed with expectancy. Hopefully within a few years no man in Denmark will have a biopsy needle targeted into their prostate before an MRI is obtained.
This project was partly supported by the Beckett Foundation and Dr Sofus Carl Emil Friis and Olga Doris Friis grant.
Boesen L, Nørgaard N, Løgager V, et al. Assessment of the Diagnostic Accuracy of Biparametric Magnetic Resonance Imaging for Prostate Cancer in Biopsy-Naive MenThe Biparametric MRI for Detection of Prostate Cancer (BIDOC) Study. JAMA Network Open. 2018;1(2):e180219. doi:10.1001/jamanetworkopen.2018.0219
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