A more reliable diagnostic tool in prostate cancer

27 Jan 2015

Targeted biopsy using new fusion technology that combines magnetic resonance imaging (MRI) with ultrasound is more effective than standard biopsy in detecting high-risk prostate cancer, according to a large-scale study. 

Clinical study with 1,000 participants

The study of 1,003 men was conducted at the NIH from 2007-2014, with Peter A. Pinto, MD, the head of the prostate cancer section of the urologic oncology branch, serving as the senior investigator. The participants were referred for biopsy because of elevated PSA or an abnormal digital rectal exam. They received targeted and concurrent standard biopsies.

Researchers found that

  • 30% more high-risk prostate cancers were diagnosed with targeted fusion-guided biopsy than with standard biopsy.
  • 17% fewer low-risk cancers were diagnosed with the new approach, compared to the older method.
  • The targeted biopsy was more reliable to predict whether the disease was low- or intermediate-risk than standard biopsy or the two approaches combined.

CareAcross-MRI

A technology for a more reliable diagnosis

"This study demonstrates that targeted fusion-guided biopsy could significantly enhance our ability to identify patients with high-risk prostate cancers that need more aggressive treatment," says lead author Mohummad Minhaj Siddiqui, MD, assistant professor of surgery at the University of Maryland School of Medicine and director of urologic robotic surgery at the University of Maryland Marlene and Stewart Greenebaum Cancer Center

"With fusion technology, we now have a tool to help us differentiate high-risk cancers from low-risk ones that may require minimal or no treatment," Dr. Siddiqui says. "There is a concern that we over-diagnose and over-treat low-risk cancers that are unlikely to be terminal, and this technology enables us to make a more reliable diagnosis than the current standard practice."

Next steps to be taken after this preliminary study

Dr. Siddiqui added that while these findings could translate into substantial benefit to patients, this study is preliminary with regard to clinical endpoints such as recurrence of disease and prostate cancer-specific mortality and consequently randomized clinical trials will be needed to determine the impact of targeted biopsy on clinical outcomes.

He plans to use MRI/ultrasound fusion in a clinical trial to identify and biopsy questionable areas within the prostate. In cases where treatment can be deferred, he will use this technology to perform more reliable active surveillance of prostate cancer requiring fewer biopsies.

If the disease requires treatment and isn't widespread, he will use focal brachytherapy (implanted radioactive seeds) to irradiate only the tumor, sparing the surrounding tissue. For patients with early-stage cancer, this option avoids many of the side effects associated with removing the prostate or irradiating the entire gland. In more severe cases, the MRI can help guide more aggressive options such as robotic surgery.

 

Source: Science Daily
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