September 27, 2024
by Elana Gotkine
Omitting biopsy in patients with negative magnetic resonance imaging (MRI) results is associated with a significantly reduced relative risk for detecting clinically insignificant prostate cancer, according to a study published in the New England Journal of Medicine.
Jonas Hugosson, M.D., Ph.D., from Sahlgrenska Academy at the University of Gothenburg in Sweden, and colleagues invited men aged 50 to 60 years to undergo prostate-specific antigen (PSA) screening in a population-based trial that started in 2015. Men with a PSA of 3 ng/mL or higher underwent MRI of the prostate. Men were randomly assigned to the systematic biopsy group, in which they underwent systematic biopsy or targeted biopsy in the case of suspicious lesions on MRI, or to targeted biopsy only. Depending on the PSA level, men were invited for repeat screening two, four, or eight years later.
After a median follow-up of 3.9 years, the researchers found that prostate cancer was detected in 185 of the 6,575 men (2.8 percent) in the MRI-targeted biopsy group and in 298 of the 6,578 men (4.5 percent) in the systematic biopsy group. Detecting clinically insignificant cancer in the MRI-targeted biopsy group versus the systematic biopsy group had a relative risk of 0.43 (95 percent confidence interval, 0.32 to 0.57) and was lower at repeat rounds of screening (relative risk, 0.25 versus 0.49). For a diagnosis of clinically significant prostate cancer, the relative risk was 0.84 (95 percent confidence interval, 0.66 to 1.07).
“These results should encourage guideline committees to update recommendations around prostate cancer diagnosis and screening,” the authors write.
More information: Jonas Hugosson et al, Results after Four Years of Screening for Prostate Cancer with PSA and MRI, New England Journal of Medicine (2024). DOI: 10.1056/NEJMoa2406050
Paul F. Pinsky, Prostate Biopsy in Men with an Elevated PSA Level — Reducing Overdiagnosis, New England Journal of Medicine (2024). DOI: 10.1056/NEJMe2409985
Journal information: New England Journal of Medicine
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