The Changing Role of MRI-Guided Biopsy

Men who are concerned about potential prostate cancer based upon repeated high PSA, but who have had a prior negative biopsy can get an MRI instead of a repeat biopsy according to a March 2016 consensus statement from the American Urological Association and the Society of Abdominal Radiology.

Using MRI to guide a biopsy, or target the biopsy needed to specific areas, has proven to be a technique that has improved ability to detect prostate cancer compared to traditional biopsy or a biopsy that is guided by TRUS.1

Groundbreaking research

In a large clinical trial, called the PRECISION study (Prostate Evaluation for Clinically Important Disease) 500 men with high PSA levels and who had a suspect DRE were given standard biopsy, biopsy guided by TRUS, or biopsy guided by MRI.1 These results were published in March 2018.2

The results show that using MRI to target a biopsy could detect prostate cancer better than the standard approach of a TRUS-guided biopsy. MRI-guided biopsy was able to detect both clinically significant prostate cancer for those with a positive scan and clinically insignificant prostate cancer better than TRUS-guided biopsy. MRI-guided biopsy also allowed for taking fewer biopsy cores, a median of 4 biopsy cores compared to the median of 12 cores used in the standard approach.2

In addition, men who had MRI-targeted biopsy were less likely to report complications than men who had a TRUS-guided biopsy at 30 days after the completion of their biopsy. These complications included blood in the urine, blood in the semen, pain at the procedural site, rectal bleeding and erectile dysfunction.2

Research guiding changes to care

Currently, The National Comprehensive Cancer Network (NCCN) recommends repeat biopsy after a negative biopsy when certain criteria are met and advises the consideration of MRI and the use of MRI guided biopsy after a negative biopsy, but does not recommend MRI use by itself.1 This may be subject to review and imminent change given the consensus statement of early 2018.

Regardless of this research and how soon it may change clinical guidelines, your healthcare team might request an MRI for a number of reasons:

  • To reveal the extent to which prostate cancer might be contained or have spread outside of the prostate gland.
  • To help exclude other reasons for a heightened PSA level, such as BPH or prostatitis, or determine if rising PSA level is due to prostate cancer.
  • If prostate cancer has spread outside of the prostate gland, to help your healthcare team determine a course of radiotherapy treatment for prostate cancer.
  • To help determine if prostate cancer has returned after treatment.
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