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MRI scans could avoid 'stab in the dark' biopsies for prostate cancer

By Ella Pickover

More than a quarter of men with suspected prostate cancer could avoid invasive biopsies if they are offered an MRI instead, a new study suggests.

Men with suspected prostate cancer are offered a biopsy which involves small samples of tissue taken from the gland and analysed for cancer.

But a new study found that if men are offered an MRI scan first, this could reduce the number who undergo biopsy by 28%.

Experts believe that more than a quarter of the one million men who currently undergo a biopsy across Europe every year could "safely avoid it".

The study, led by researchers from University College London, found that an MRI scan and targeted prostate biopsies detected more harmful cancers that needed treatment and reduced over-diagnosis of less harmful cancers.

The trial, presented at the European Association of Urology Congress in Copenhagen, with publication in the New England Journal of Medicine, saw researchers from 23 centres randomly allocate 500 men with suspected prostate cancer to be examined either with a standard biopsy or with an initial MRI scan followed by a targeted biopsy if the MRI showed an abnormality.

The Precision Trial found that 71 (28%) of the 252 men in the MRI arm of the study avoided the need for a subsequent biopsy.

Of those who needed a biopsy, the researchers detected clinically significant cancer in 95 (38%) of the 252 men, compared to 64 (26%) of the 248 men who received only the biopsy.

First author of the study, Dr Veeru Kasivisvanathan from UCL Division of Surgery and Interventional Science, said: "In men who need to have investigation for prostate cancer for the first time, Precision shows that using an MRI to identify suspected cancer in the prostate, and performing a prostate biopsy targeted to the MRI information, leads to more cancers being diagnosed than the standard way that we have been performing prostate biopsy for the last 25 years."

Colleague Professor Mark Emberton added: "This study was the first to allow men to avoid a biopsy. If high quality MRI can be achieved across Europe, then over a quarter of the one million men who currently undergo a biopsy could safely avoid it."

Commenting on the study, Karen Stalbow, head of policy, knowledge and impact at the charity Prostate Cancer UK, said: "For too long men have had to endure a stab in the dark biopsy technique which can miss one in four harmful prostate cancers. This is simply not good enough.

"It is now more important than ever that all men with suspected prostate cancer get a multiparametric MRI scan before biopsy. This will not only reduce the number of unnecessary biopsies for men with no or low grade cancer, but will also ensure that those men with more harmful types of the disease will benefit from a much more targeted approach, reducing the chances that their cancer is missed."

There are more than 11,000 deaths from prostate cancer in the UK every year.

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