The screening and diagnosis of prostate cancer by PSA serum testing and random ultrasound guided biopsies has been controversial. At the forefront of this controversy are limitations of PSA (it can be elevated due to cancer, but also from benign enlargement of the prostate or inflammation) and of ultrasounds which cannot readily identify prostate cancer visually. A breakthrough, multi-institutional, multi-national study recently published in the New England Journal of Medicine now lends the highest level of evidence supporting a new paradigm of prostate cancer diagnosis.
MRI Superior to Traditional Ultrasound
The study, run by the PRECISION Study Group, investigated whether the superior ability of multi-parametric prostate MRI (mpMRI) to visualize clinically important prostate cancer and help target biopsies could reduce unnecessary biopsies and still identify clinically significant disease when present. Randomizing men with suspicion of prostate cancer (i.e. with elevated PSA) to either traditional ultrasound guided biopsies or to MRI first and then targeted biopsies if needed, the PRECISION Study Group found that use of MRI prior to biopsy allowed almost 30% of the men to avoid biopsy all together and was more adept at detecting important cancers.
New Standard of Care
The study group concluded that a strategy of MRI for risk assessment prior to biopsy for men with elevated PSA is the superior approach and should be the new standard of care.
Of course, for this strategy to be successful the MRI must be performed, read, and utilized by experienced centers and physicians. Texas Center for Proton Therapy utilizes a 3 Tesla (3T) MRI to provide exceptional image clarity. This, along with computer-aided tumor detection, allows men with elevated PSA or other suspicion of prostate cancer to have a thorough evaluation. Find out more about the new study here.
- Dr. Andrew Lee, medical director, Texas Center for Proton Therapy and Dr. Ashley Ross, Texas Urology Specialists