Our Summary

This research paper is about a comparison of two different methods for detecting prostate cancer. The first method involves using a type of scan called multi-parametric Magnetic Resonance Imaging (mpMRI), while the second method does not use this scan.

The study was conducted over a year, from January 2019 to March 2020 and the patients were split into two groups. Group A were patients who had never had a biopsy before and underwent an mpMRI scan at any institution. Group B were patients who had not had an mpMRI scan.

The study found that the overall rate of detecting prostate cancer was slightly higher in Group A (52.3%) than in Group B (48.4%), but this difference was not significant. However, the rate of detecting non-serious prostate cancer was lower in Group A (7.8%) than in Group B (13.3%). This suggests that using mpMRI can help to identify serious cases of prostate cancer while avoiding over-diagnosis of non-serious cases.

However, the study also found that some patients in Group A who had a negative mpMRI scan (indicating no prostate cancer) actually had serious prostate cancer. This suggests that even if a mpMRI scan is negative, a biopsy may still be needed to ensure that no cancer is present.

The study concluded that using mpMRI can be beneficial in detecting prostate cancer, but it should not replace the need for a biopsy, especially in cases where the scan is not centralized. The researchers also identified factors that can predict the presence of prostate cancer, including the volume of the prostate, the patient’s age, and the level of a protein called PSA in the blood.

FAQs

  1. What is the difference in prostate cancer detection between patients who underwent mpMRI and those who did not?
  2. What factors were found to predict the detection of prostate cancer in the study?
  3. Does a negative mpMRI result mean there is no need for a biopsy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about prostate biopsy is to discuss the option of undergoing a multi-parametric Magnetic Resonance Imaging (mpMRI) before the biopsy. This can help in better detection of prostate cancer and reduce the chances of detecting non-clinically significant disease. It is important to understand that even if the mpMRI results are negative, it does not completely rule out the need for a biopsy, especially if the mpMRI is not centralized. It is also important to consider factors such as age, PSA levels, and prostate volume when deciding on the need for a biopsy.

Suitable For

Patients who are typically recommended for a prostate biopsy include those with elevated prostate-specific antigen (PSA) levels, abnormal digital rectal exam findings, or a family history of prostate cancer. Additionally, patients who have undergone a multi-parametric Magnetic Resonance Imaging (mpMRI) and have suspicious findings (PIRADS 3-5) may also be recommended for a biopsy. The study mentioned in the abstract compared the pathway including mpMRI versus the one without mpMRI in the detection of prostate cancer, highlighting the importance of mpMRI in improving the detection of clinically significant prostate cancer.

Timeline

Before prostate biopsy:

  1. Patient undergoes initial screening tests such as digital rectal exam (DRE) and prostate-specific antigen (PSA) test.
  2. Patient may be referred for multi-parametric Magnetic Resonance Imaging (mpMRI) to assess the prostate.
  3. If mpMRI is positive for suspicious lesions, patient may be scheduled for a fusion biopsy.
  4. If mpMRI is negative, patient may undergo a standard biopsy.

After prostate biopsy:

  1. Patient undergoes the biopsy procedure, which may be trans-perineal.
  2. Biopsy samples are analyzed for the presence of prostate cancer.
  3. Results are communicated to the patient, indicating whether cancer is present and if so, its clinical significance.
  4. Treatment options are discussed based on biopsy results and patient’s overall health status.

What to Ask Your Doctor

  1. What is the purpose of a prostate biopsy?
  2. What are the risks and potential complications of a prostate biopsy?
  3. How is a prostate biopsy performed?
  4. What is the difference between a standard biopsy and a cognitive fusion biopsy?
  5. How accurate is a multi-parametric Magnetic Resonance Imaging (mpMRI) in detecting prostate cancer?
  6. How does the use of mpMRI impact the detection of clinically significant prostate cancer?
  7. If my mpMRI is negative, does that mean I do not need a biopsy?
  8. What factors should be considered when determining the need for a prostate biopsy?
  9. How will the results of the biopsy impact my treatment plan?
  10. Are there any alternative tests or procedures that can be considered instead of a prostate biopsy?

Reference

Authors: Bertolo R, Vittori M, Cipriani C, Maiorino F, Forte V, Iacovelli V, Petta F, Sperandio M, Marani C, Panei M, Travaglia S, Bove P. Journal: Prog Urol. 2021 Oct;31(12):739-746. doi: 10.1016/j.purol.2020.12.008. Epub 2021 Jan 9. PMID: 33431200