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Prostate cancer – Drastic reduction in biopsies is possible

The extent to which MRI scans can spare men suspected of having prostate cancer unnecessary biopsies and prevent needless treatment has been highlighted by an authoritative new research paper.

The extent to which MRI scans can spare men suspected of having prostate cancer unnecessary biopsies and prevent needless treatment has been highlighted by an authoritative new research paper.

The extent to which MRI scans can spare men suspected of having prostate cancer unnecessary biopsies and prevent needless treatment has been highlighted by an authoritative new research paper.

The paper’s lead author is Prof Anwar Padhani, a world-renowned expert on the subject and lead consultant for MRI at Paul Strickland Scanner Centre. It was published in the journal Radiology in 2019 and includes the results of April’s highly influential Oxford Cochrane review into how good MRI is at diagnosing prostate cancer, by analysing more than 30 studies on the subject.

Professor Anwar Padhani
Professor Anwar Padhani

The Cochrane Review represents the highest standard in evidence-based health care research. Prof Padhani said: “We know that about 300 out of every 1,000 patients suspected of having cancer will have disease that could be potentially harmful. In the past, all 1,000 would have had a biopsy to diagnose the 30%, meaning that 700 men would be exposed to potential risks and complications of unnecessary biopsy despite having no cancer.

“But we now know that if all 1,000 men had an MRI scan first, 672 of the 700 disease free men could be identified as definitely not having cancer and not needing a biopsy, with only 28 men needing a biopsy to confirm the absence of cancer.

The Cochrane review also shows the number of cancers missed by MRI is smaller than the traditional method of biopsy (84 by MRI versus 111 by transrectal biopsies). Furthermore, if men first have an MRI scan, the cancers missed are mostly the less dangerous “microfocal” cancers which have a good outcome even if they are diagnosed later during follow-up by their GP. The Cochrane review and other supportive studies also show that the number of needles used during a biopsy can be drastically reduced, so further lowering the chance of infection.

Prof Padhani and his colleagues are keen supporters of MRI being used as a diagnostic tool for prostate cancer early in the patient journey. He said: “MRI as a first diagnostic tool in appropriately chosen men is now accepted in the European and UK guidelines. The guidelines now say that every man should first have an MRI scan before having a biopsy and our paper describes the patient pathway in detail and how to deliver benefit to patients in daily practice.”

One key issue identified by Prof Padhani and his colleagues is the management of patients who have an elevated PSA level but where the MRI scan shows them to be cancer-free. He said: “We suggest GPs are alerted to keep an eye on the patient with regular blood tests as part of a safety net. This could be based on watching for rises in PSA over time and to re-refer the patient to hospital when certain trigger points are reached.”

For an in-depth video presentation meant for medical professionals on the subject by Prof Padhani, please ask your health care professional to view https://youtu.be/BcfY0yIy4dY

Professor Anwar Padhani. Delivering the promise of PI-RADS mpMRI pathway

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