Our Summary

The research paper’s main aim was to develop strategies that could improve the current practice of prostate biopsy by identifying patients who could safely skip the standard systematic biopsy (SBx) and instead rely on MRI-targeted biopsies (TBx) alone.

The study analyzed data from 745 patients who had both types of biopsies. The researchers were specifically interested in cases where the standard biopsy detected significant prostate cancer (csPCa) that wasn’t found by the MRI-targeted biopsy. They looked at various factors like age, previous biopsy results, MRI score, size and location of potential cancer, number of potential cancer sites, and PSA levels to see what affected the chances of the standard biopsy identifying significant cancer.

The study found that the standard biopsy detected significant prostate cancer in an additional 6% of men. The chances of finding such cancer only with the standard biopsy were lower in men with high MRI scores and in men who had previously had a biopsy that didn’t find cancer. The chances increased with age.

Based on these results, the researchers suggest two strategies that could be useful: (1) skipping the standard biopsy in men with high MRI scores and (2) also skipping it in men with previously negative biopsies. These strategies could reduce the number of unnecessary standard biopsies by 27% and 58%, respectively, while only missing a very small number of significant cancer cases (1% and 2%, respectively).

In simple terms, certain men might not need to have the standard biopsy and could instead rely on the MRI-targeted biopsy. This could reduce the number of unnecessary biopsies, making the process less stressful and invasive for those men.

FAQs

  1. What was the main aim of the research paper on prostate biopsy?
  2. What factors did the researchers consider when analyzing the effectiveness of standard biopsies versus MRI-targeted biopsies?
  3. Based on the research, what strategies are suggested to improve the current practice of prostate biopsy?

Doctor’s Tip

A helpful tip a doctor might give a patient about prostate biopsy is to discuss with their healthcare provider if they might be a candidate for skipping the standard biopsy and instead relying on an MRI-targeted biopsy. This approach could potentially reduce the need for unnecessary biopsies and still accurately detect significant prostate cancer. It’s important to have an open and informed discussion with your doctor about the best approach for your individual situation.

Suitable For

Typically, patients who are recommended for prostate biopsy are those who have abnormal digital rectal exam (DRE) findings, elevated prostate-specific antigen (PSA) levels, or abnormal results from a previous biopsy. Additionally, patients with a family history of prostate cancer or other risk factors may also be recommended for a biopsy. The findings of this study suggest that certain patients with high MRI scores or previous negative biopsy results may be able to skip the standard biopsy and rely on MRI-targeted biopsies alone.

Timeline

Before the prostate biopsy:

  1. Patient will undergo a physical examination and discuss symptoms with their doctor.
  2. Blood tests will be conducted to measure PSA levels.
  3. Patient may undergo a digital rectal exam to check for abnormalities in the prostate.
  4. If PSA levels are elevated or abnormalities are found, patient may be recommended for a prostate biopsy.

During the prostate biopsy:

  1. Patient will be positioned on their side or back.
  2. Local anesthesia will be administered to numb the area.
  3. A thin needle will be inserted through the rectum or perineum to collect tissue samples from the prostate.
  4. Patient may experience discomfort or pain during the procedure.

After the prostate biopsy:

  1. Patient may experience some bleeding or blood in the urine or semen for a few days.
  2. Patient may be advised to avoid heavy lifting or strenuous activities for a week.
  3. Patient will receive the biopsy results within a week or two.
  4. If cancer is detected, patient will discuss treatment options with their doctor.

After the study’s recommendations:

  1. Patient may be recommended for an MRI-targeted biopsy instead of the standard biopsy.
  2. If patient has high MRI scores or previously negative biopsies, they may skip the standard biopsy altogether.
  3. This could reduce the number of unnecessary biopsies and make the process less invasive for certain patients.

What to Ask Your Doctor

Some questions a patient should ask their doctor about prostate biopsy based on this research include:

  1. Based on my MRI score and previous biopsy results, do you think I could safely skip the standard biopsy and rely on MRI-targeted biopsies alone?

  2. Are there any specific factors in my case, such as age or PSA levels, that make me a good candidate for skipping the standard biopsy?

  3. What are the potential risks and benefits of skipping the standard biopsy and relying solely on MRI-targeted biopsies?

  4. If I do skip the standard biopsy, what is the likelihood of missing significant prostate cancer that may have been detected by the standard biopsy?

  5. How would skipping the standard biopsy impact my treatment plan and follow-up care if significant cancer is later detected?

  6. Are there any other factors or considerations that we should take into account when deciding whether or not to skip the standard biopsy?

Reference

Authors: Deniffel D, Perlis N, Ghai S, Girgis S, Healy GM, Fleshner N, Hamilton R, Kulkarni G, Toi A, van der Kwast T, Zlotta A, Finelli A, Haider MA. Journal: Eur Radiol. 2022 Nov;32(11):7544-7554. doi: 10.1007/s00330-022-08822-3. Epub 2022 May 4. PMID: 35507051