Abnormal results of a prostate-specific antigen (PSA) screening test for cancer normally follow a routine biopsy. During this procedure, doctors use a protracted needle to remove a few dozen samples from the prostate while viewing the gland on an ultrasound machine. These samples can then be checked for cancer under a microscope.
Limitations and concerns
But systematic biopsy may be difficult. A serious concern is that they overdiagnose low-grade, slow-growing tumors which will never grow to be life-threatening, thus resulting in unnecessary treatment.
Researchers are exploring alternatives to routine biopsy in flagrant men through PSA screening. One option is to start out with a magnetic resonance imaging (MRI) scan of the prostate, after which focus the biopsy only on areas that look suspicious for cancer. This is named an MRI-targeted biopsy, and it’s becoming increasingly common.
Can MRI miss early-stage cancers that later prove incurable? This is an impressive concern, especially since routine biopsies sometimes detect newly formed cancers that MRIs haven’t yet detected. In fact, systematic and targeted biopsies are sometimes given. together To increase the chances of finding a clinically significant disease which will require immediate treatment.
Procedure
Now, a giant one Swedish studies provides encouraging evidence in favor of the MRI-only approach.
The team invited 38,316 men aged 50 to 60 for PSA screening. If a person had a PSA level of three.0 nanograms per milliliter (ng/mL) or higher, he was included within the study. The investigators recruited 13,153 men with injuries who were randomly divided between two groups.
- Systematic Biopsy Group: All men on this group received an MRI along with a scientific biopsy. If a person's MRI was positive for suspicious lesions, he also underwent a targeted biopsy.
- MRI-Targeted Biopsy Group: All men on this group underwent an MRI, but none received a scientific biopsy. Men with suspicious lesions on MRI received a targeted biopsy.
This initial screening round is followed by repeat screening rounds – all following the identical protocol – at two-, four- and eight-year intervals.
What the study showed
After a median follow-up of three.9 years (starting and including the primary screening round), 185 men within the MRI-targeted group and 298 men within the systematic biopsy group were diagnosed with prostate cancer. Systematic biopsies yielded more clinically insignificant cancer diagnoses—159 compared with 68 within the MRI-targeted group. During the primary screening round, “the risk of such a diagnosis was 51 percent lower in the MRI-targeted biopsy group than in the managed biopsy group,” the authors wrote.
The authors emphasized that omitting biopsy in patients with negative MRI findings clinically underestimates the prognosis. Unusual Cancer, meaning cancer that grows slowly and will never require treatment, accounts for greater than half. Dr Jonas Hugosson, chief urologist on the University of Gothenburg and first creator of the study, said, “And importantly, the risk of detecting clinically significant cancers was very low in both groups during follow-up and during subsequent screening. ” “A total of 14 such cases (0.2% of men who participated) were diagnosed in the systematic biopsy group and eight (0.1%) in the MRI-targeted biopsy group.”