Our Summary

This study looks at the use of MRI-guided prostate biopsies (MRGB) to diagnose prostate cancer. The authors examined data from 554 men who had 607 biopsies between 2013 and 2018. They found that MRGB was successful in detecting cancer in 80% of the patients and 76% of the targets. The study also found that the ability of MRGB to detect significant cancer was 55% at the patient level and 59% at the target level. In men who had previously tested negative for prostate cancer, MRGB found cancer in 60% of cases. Among men who were being actively monitored for prostate cancer, 50% were found to have more serious disease using MRGB. The study also found that the patient’s age, the PI-RADS™ score (a measure of how likely it is that a lesion in the prostate is cancerous), and the PSAD value (a measure of prostate size) were all predictors of significant disease. The authors also reviewed 23 other studies on MRGB, which involved around 4,000 patients in total. In these studies, the overall cancer detection rate ranged from 23% to 74%, and significant disease was detected in 63% of cases overall. The authors conclude that MRGB is effective at diagnosing cancer, particularly in men who have previously tested negative or are being actively monitored. However, more research is needed on its use in certain cases.

FAQs

  1. What is the success rate of MRI-guided prostate biopsies (MRGB) in detecting prostate cancer?
  2. Are there any factors that can predict the presence of significant disease in a prostate biopsy?
  3. What is the effectiveness of MRGB in diagnosing prostate cancer in men who have previously tested negative or are being actively monitored?

Doctor’s Tip

One helpful tip a doctor might tell a patient about prostate biopsy is to discuss the risks and benefits of the procedure beforehand. It’s important for the patient to understand that while a biopsy can help diagnose prostate cancer, it can also come with risks such as infection, bleeding, or discomfort. The patient should also be aware of the potential outcomes of the biopsy results and what further steps may be needed depending on the findings. Additionally, it’s important for the patient to follow any pre-biopsy instructions provided by the doctor, such as avoiding certain medications or foods before the procedure.

Suitable For

Patients who are typically recommended for prostate biopsy include:

  1. Patients with abnormal digital rectal exam (DRE) findings: If a healthcare provider feels a lump or abnormality during a DRE, a prostate biopsy may be recommended to further investigate the possibility of prostate cancer.

  2. Patients with elevated prostate-specific antigen (PSA) levels: High levels of PSA in the blood can be a sign of prostate cancer, although it can also be elevated due to other conditions such as prostate enlargement or inflammation. A prostate biopsy may be recommended if PSA levels are elevated and other tests suggest a potential risk of cancer.

  3. Patients with abnormal findings on imaging tests: If imaging tests such as MRI or ultrasound show suspicious areas in the prostate, a biopsy may be recommended to confirm or rule out the presence of cancer.

  4. Patients with a family history of prostate cancer: Men with a family history of prostate cancer, especially in close relatives such as a father or brother, may be at an increased risk of developing the disease. In such cases, a healthcare provider may recommend regular screening tests including prostate biopsy.

  5. Patients with a previous negative biopsy but persistent symptoms: In some cases, a previous prostate biopsy may have been negative for cancer, but symptoms or other test results suggest a continued risk. In such cases, a repeat biopsy may be recommended to ensure an accurate diagnosis.

Overall, the decision to recommend a prostate biopsy is based on a combination of factors including symptoms, test results, risk factors, and individual patient characteristics. It is important for patients to discuss their concerns and preferences with their healthcare provider to determine the most appropriate course of action.

Timeline

Before a prostate biopsy, a patient may experience symptoms such as frequent urination, difficulty urinating, blood in the urine, or elevated PSA levels. They may undergo a digital rectal exam (DRE) and a transrectal ultrasound (TRUS) to assess the prostate before the biopsy.

During the prostate biopsy procedure, the patient will be positioned on their side with their knees drawn up towards their chest. Local anesthesia will be administered to numb the area, and a biopsy needle will be inserted through the rectum to collect tissue samples from the prostate gland.

After the prostate biopsy, the patient may experience temporary side effects such as blood in the urine or semen, pain or discomfort in the rectal area, and difficulty urinating. Results from the biopsy may take a few days to a week to come back, and the patient will meet with their healthcare provider to discuss the findings and determine the next steps for treatment or monitoring.

Overall, the prostate biopsy process involves a series of steps from initial symptoms and testing to the biopsy procedure itself and follow-up care based on the results.

What to Ask Your Doctor

  1. What are the reasons for recommending a prostate biopsy?
  2. How will the biopsy be performed and what can I expect during the procedure?
  3. What are the potential risks or complications associated with a prostate biopsy?
  4. How accurate is the MRI-guided prostate biopsy in detecting prostate cancer?
  5. What does the PI-RADS™ score mean and how does it impact the likelihood of cancer detection?
  6. How will the results of the biopsy be communicated to me?
  7. What are the next steps if cancer is detected?
  8. Are there alternative tests or procedures that could be considered instead of a biopsy?
  9. How often should I undergo follow-up screenings or biopsies if cancer is not detected?
  10. Are there any lifestyle changes or interventions that could help reduce the risk of prostate cancer or improve treatment outcomes?

Reference

Authors: Pokorny M, Kua B, Esler R, Yaxley J, Samaratunga H, Dunglison N, Gianduzzo T, Coughlin G, Holt R, Laing B, Ault D, Brown N, Parkinson R, Thompson L. Journal: World J Urol. 2019 Jul;37(7):1263-1279. doi: 10.1007/s00345-018-2497-y. Epub 2018 Sep 25. PMID: 30255394