Prostate biopsies have been performed to excess for the purpose of evaluating a high PSA levels (prostate specific antigen). A high PSA often comes from prostate enlargement or inflammation rather than cancer. In addition, many prostate cancers are clinically insignificant, meaning they would never result in death.
Standard management of an elevated PSA levels has been to perform random biopsies under ultrasound guidance from 10-12 sites within the prostate. This exposes the patient to significant and sometimes undue risk from infection, bleeding, and pain. Biopsy may also may miss a cancer that is not seen with ultrasound.
A new study reveals that MRI-guided biopsy is superior to ultrasound-guided biopsy for suspected prostate cancer. (NEJM May 10, 2018, pp 1767-1777). MRI (magnetic resonance imaging) is a non-invasive study without radiation exposure, which provides a definitive view of the prostate.
In this study, the standard ultrasound-guided biopsy group, all men underwent biopsy. In the MRI-targeted group, 28% of the patients had MRI results that did not suggest the presence of cancer, and thus did not undergo biopsy. Clinically significant cancer was detected in 38% of the MRI-targeted group, and only in 26% of the standard-biopsy group. Fewer men in the MRI-targeted group had clinically insignificant cancer than the standard ultrasound-guided group. This means many men were spared having biopsy for cancer that would not have progressed and did not require treatment.
If you have a high PSA, get an MRI study before you consent to a biopsy. This may spare you from a biopsy, is more accurate than ultrasound in finding disease, and prevents random needle punctures throughout the prostate. If you have questions before receiving invasive diagnostic testing or therapy, make an appointment with one of our doctors. We can help you decide what to do next.
-Allan Sosin MD