CINCINNATI--Researchers at the University of Cincinnati (UC) have found that MRI fusion biopsy--coupling MRI and ultrasound to visualize suspicious lesions in the prostate gland and targeting the biopsy to that particular area--outperformed standard prostate biopsy in patients with a prior negative prostate biopsy.
This data, published in the May 10 advance online edition of the journal Urologic Oncology, could provide a new standard of care when screening men for prostate cancer and could lead to more efficient practices, saving time and money and improving diagnosis times for patients.
"In this study, we used a large multi-institutional sample size," says Abhinav Sidana, MD, director of urologic oncology and assistant professor in the Division of Urology at the UC College of Medicine and the corresponding author on this study. "In men with suspicion of having prostate cancer, standard (collecting 12 samples from the prostate), or saturation (collecting 20-40 samples from the prostate), biopsy, a more randomized approach, has traditionally been a principal method for diagnosis. However, this can lead to overdiagnosis of clinically insignificant cancer, meaning prostate cancer where treatment is not needed, underdiagnosis of clinically significant cancer, meaning prostate cancer where treatment is needed, and has a high false-negative rate, meaning tests that read negative for cancer when it is truly malignant.
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"Patients with continued suspicion of prostate cancer and negative prior prostate biopsy are a diagnostic challenge, and around 38 percent will undergo repeat standard or saturation biopsy over five years in order to obtain a diagnosis. Unfortunately, repeating this has little efficacy in identifying cancerous lesions with only a 10 to 25 percent cancer detection rate even after the fourth repeat biopsy. These multiple re-biopsies also lead to increased cost, delayed diagnosis and could contribute to progression of a patient's disease."
Sidana, who is also a UC Health urologist and a member of the UC Cancer Institute, says that MRI fusion biopsy has emerged as a promising alternative because of its ability to help physicians identify clinically significant cancers and that several single-institution studies have found the benefit of this method in detecting prostate cancer in patients with prior negative prostate biopsies. However, the analysis in relation to the number of prior negative biopsies a patient had was limited.