MRI-Targeted Biopsy, Beneficial to Men With Elevated PSA, in Men aged 50-60years

Fewer men in the experimental group received a diagnosis of clinically insignificant prostate cancer

For men with elevated prostate-specific antigen (PSA) levels, magnetic resonance imaging (MRI)-directed targeted biopsy seems better for screening and early detection than systematic biopsy, according to a study published in an issue of the New England Journal of Medicine.

Jonas Hugosson, M.D., Ph.D., from Sahlgrenska University Hospital in Gothenburg, Sweden, and colleagues invited men aged 50 to 60 years to undergo regular PSA screening.

Those with a PSA level of 3 ng/mL or higher underwent prostate MRI. One-third were randomly assigned to a reference group (5,994 participants) that underwent systematic biopsy and targeted biopsy of suspicious lesions; the experimental group, which included two-thirds of participants (11,986 participants), underwent targeted biopsy only.

The researchers found that 0.6 and 1.2 percent of participants in the experimental and reference groups received a diagnosis of clinically insignificant prostate cancer (relative risk, 0.46; 95 percent confidence interval, 0.33 to 0.64).

In the experimental versus the reference group, the relative risk of clinically significant prostate cancer was 0.81 (95 percent confidence interval, 0.60 to 1.1). Ten participants in the reference group had clinically significant cancer only detected by systematic biopsy; all cases were of intermediate risk and were mainly low-volume diseases managed with active surveillance.

“We found that a screening algorithm that included PSA measurement followed by MRI evaluation and targeted biopsy only, as compared with systematic biopsy of all participants with elevated PSA, led to a substantial reduction of over diagnosis at the cost of missing a limited number of clinically significant cancers,” the authors write.

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