MRI-Targeted or Standard Biopsy for Prostate Cancer Diagnosis

Research output: Contribution to journalArticle

Authors

  • Veeru Kasivisvanathan
  • Antti S. Rannikko
  • Marcelo Borghi
  • Valeria Panebianco
  • Lance A. Mynderse
  • Markku H. Vaarala
  • Alberto Briganti
  • Lars Budäus
  • Giles Hellawell
  • Richard G. Hindley
  • Monique J. Roobol
  • Scott Eggener
  • Maneesh Ghei
  • Arnauld Villers
  • Franck Bladou
  • Geert M. Villeirs
  • Jaspal Virdi
  • Silvan Boxler
  • Grégoire Robert
  • Paras B. Singh
  • Wulphert Venderink
  • Boris A Hadaschik
  • Alain Ruffion
  • Jim C. Hu
  • Daniel Margolis
  • Sébastien Crouzet
  • Laurence Klotz
  • Samir S. Taneja
  • Peter Pinto
  • Inderbir Gill
  • Clare Allen
  • Francesco Giganti
  • Alex Freeman
  • Stephen Morris
  • Shonit Punwani
  • Norman R. Williams
  • Chris Brew-Graves
  • Mark Emberton
  • Caroline M. Moore

Colleges, School and Institutes

Abstract

BackgroundThe use of multiparametric MRI ± targeted biopsy (MRI±TB) is an alternative to standard transrectal ultrasound guided (TRUS) biopsy for prostate cancer detection in biopsy-naïve men with raised prostate specific antigen (PSA). However, comparative evidence is lacking.MethodsPRECISION was a randomized, multicenter, non-inferiority trial, allocating 500 biopsy-naïve men with clinical suspicion of prostate cancer to MRI±TB or standard TRUS biopsy. Men randomized to MRI±TB had targeted biopsy (without standard biopsy cores) if the MRI was suspicious (PIRADSv2 score ≥3). Men with a non-suspicious MRI were not offered biopsy. Standard biopsy was a 10-12 core TRUS biopsy. The primary outcome was the proportion of men diagnosed with clinically significant cancer (Gleason grade ≥3+4). Planned secondary outcomes included the proportion of men diagnosed with clinically insignificant cancer (Gleason grade 3+3).ResultsOf the 252 men allocated to MRI±TB, 71 (28%) had a non-suspicious MRI and did not undergo biopsy. Clinically significant cancer was detected in 95 (38%) of 252 men in the MRI±TB arm compared to 64 (26%) of 248 men randomized to TRUS biopsy (adjusted difference, 11.7% [95% CI 3.6 to 19.8], P=0.005). MRI±TB was non-inferior to TRUS biopsy and the 95% CI indicated superiority of MRI±TB over TRUS biopsy. MRI±TB also diagnosed fewer men with insignificant cancer than TRUS biopsy (adjusted difference, -13.1% [95% CI -19.3 to -6.8, P<0.001]).ConclusionsPre-biopsy MRI risk assessment and MRI-targeted biopsy is superior to TRUS biopsy in biopsy-naïve men at clinical risk of prostate cancer.(Funded by the National Institute for Health Research (NIHR) and the European Association of Urology Research Foundation; Trial registration number: NCT02380027)

Details

Original languageEnglish
JournalThe New England Journal of Medicine
Early online date19 Mar 2018
Publication statusE-pub ahead of print - 19 Mar 2018