Combining MRI biopsy prostate biopsy with standard 12 points under ultrasound guidance exceeds any mono-aggressive method with exclusion of cancer types, and shows better results, compared to the MRI biopsy, with clinically significant identification of tumors. This new study of the National Cancer Institute.

In the case of the 2103 men who underwent MRI biopsy followed by systematic biopsy combined approach has led to an increase in the number of cancer diagnoses for 10% and increasing Gleason score, compared with any other technique.

The study was published in the magazine «New England Journal of Medicine».

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"Among patients with visible using MRI prostate lesions, the addition of MRI-targeted biopsies to systematic biopsy increased recognizability of clinically significant cancers (at grade ≥3) and led to a decrease in detection of clinically insignificant cancers," - the researchers noted.

Although many of these benefits were obtained only thanks to a targeted MRI biopsy at default systematic biopsy would not have received a diagnosis of 8.8% of clinically significant cancers. However, according to the authors, combined technique is time-consuming and technically complicated, so it will not soon become common in clinical practice.

Alexander Kutikov, MD Cancer Center. Fox Chase in Philadelphia, said that the combined method is a paradigm shift in the diagnosis of prostate cancer, especially in its ability to distinguish between cancers that can be safely monitored via observation.

"This technology has two practical results, - said the scientist -.. First, you perform better biopsy, mainly minimizing nediagnostiku clinically significant cancers Secondly, you minimize the hyperdiagnosis cancer Gleason score (measure 6), the treatment of which can worsen the lives of people and that might not necessarily be diagnosed. "

Previous studies have shown that MRI-Targeted biopsy reveals a high level of cancer malignancy is better than the systematic biopsy, but the effectiveness of replacing systematic biopsy on MRI biopsy, or combining them remained unclear. In the new study, scientists have tried to answer this question.

The study involved men 18 years and older who had elevated PSA level, or the results of a digital rectal exam were suspicious. Participants underwent an MRI apparatus using a 3-Tesla and an endorectal coil. Lesions visualized on MRI, was assigned a score between 1 and 5 according to the reports and data prostate imaging system (PI-RADS), wherein the higher scores indicated lesion with higher clinical suspicion. Until April 2105, when researchers began using PI-RADS assessment system, they used a 5-point scoring system developed by the National Institutes of Health, which has been shown to correlate with PI-RADS assessments.

Lesions were identified for biopsy radiologist, and was determined to a maximum of 5 points for each patient. Then, participants were first MRI-targeted biopsies, in which MRI images to be superimposed on the ultrasound images in real-time goods for the detection of lesions. After the first image superimposed biopsy removed, and the other doctor performing systematic biopsy 12 points under ultrasound guidance alone.

In the case of patients undergoing post-radical prostatectomy, scientists considered decrease or increase the degree of malignancy. Clinically insignificant cancer group was defined as 1 degree (Gleason score 3 + 3 = 6). Clinically significant cancer group was defined as grade 3 (Gleason score 4 + 3 = 7, unfavorable intermediate risk) or higher. The researchers also reported that a group of 2nd degree (Gleason score 3 + 4 = 7, a favorable intermediate risk).

Of the 2103 men who underwent a biopsy combined, in 1,312 people were diagnosed with cancer and 404 people underwent radical prostatectomy.

Only one systematic biopsy diagnosed with cancer in 1104 patients (52.5%), and the MRI biopsy - in 1084 patients (51.5%).

Detection of cancer in accordance with the scale Gleason primary endpoint was significantly better in the combination biopsy Group 3rd, 4th and 5th degree but less cancers in Group 1-th degree.

When the results of MRI biopsy were added to the systematic biopsy, it was diagnosed in 208 (9.9%) more cancers, and 59 of them were clinically meaningful (group 3-degree or higher).


Date of publication: 
Wednesday, March 11, 2020