Editing Prostate Cancer: Diagnosis and evaluation (section)

====== <span style="color:#ff0000">Advantages</span> ======

* '''Compared to pathway of elevated PSA to TRUS-guided biopsy without MRI, pathway of elevated PSA to MRI with targeted biopsy''' 
** '''Improves identification of anterior tumors'''
** '''Reduces over diagnosis of clinically insignificant prostate cancer'''
** '''Increases diagnosis of clinically significant prostate cancer'''
*** '''≈10%''' (but up to 20%) '''of negative MRI have clinically significant prostate cancer'''
* '''<span style="color:#ff00ff">PRECISION (2018)</span>'''
** Objective: in males with clinical suspicious of prostate cancer, determine whether prostate MRI with targeted biopsy only can increase detection of clinically significant prostate cancer and decrease detection of clinically insignificant prostate cancer
** '''Design: Non-inferiority trial'''
** '''<span style="color:#ff0000">Population: 500 males with clinical suspicion of prostate cancer based on elevated PSA or abnormal DRE</span>'''
** '''<span style="color:#ff0000">Randomized to standard TRUS–guided biopsy vs. MRI +/- targeted biopsy</span>'''
*** '''Males in the MRI group underwent a targeted biopsy (without standard biopsy cores) if the MRI was suggestive of prostate cancer; if MRI results were not suggestive of prostate cancer, males were not offered biopsy'''
** '''Outcomes'''
*** '''Primary: proportion of males who received a diagnosis of clinically significant cancer'''
*** Secondary: proportion of males who received a diagnosis of clinically insignificant cancer
** '''<span style="color:#ff0000">Results:</span>'''
*** '''<span style="color:#ff0000">MRI-targeted biopsy was non-inferior and superior to detecting clinically significant cancer</span>''' (absolute risk difference 12%, 38% MRI vs. 26% standard TRUS)
*** '''<span style="color:#ff0000">MRI-targeted biopsy was associated with fever patients being diagnosed with clinically insignificant cancer</span>''' (absolute risk difference -13%)
** Authors’ conclusion: Using MP-MRI to triage men might allow 27% of patients avoid a primary biopsy and diagnosis of 5% fewer clinically insignificant cancers. If subsequent TRUS-biopsies were directed by MP-MRI findings, up to 18% more cases of clinically significant cancer might be detected compared with the standard pathway of TRUS-biopsy for all. MP-MRI, used as a triage test before first prostate biopsy, could reduce unnecessary biopsies by a quarter. MP-MRI can also reduce over-diagnosis of clinically insignificant prostate cancer and improve detection of clinically significant cancer.
** [https://pubmed.ncbi.nlm.nih.gov/29552975/ Kasivisvanathan, Veeru, et al.] "MRI-targeted or standard biopsy for prostate-cancer diagnosis." New England Journal of Medicine 378.19 (2018): 1767-1777.
* '''<span style="color:#ff00ff">STHLM3 - MRI-targeted vs. standard biopsy in prostate cancer screening</span>'''
**'''Population: 1532 males aged 50-74 years with screening PSA > 3 ng/mL'''
***Screening population in STHLM3, compared to patients referred for abnormal PSA or DRE in PRECISION
**'''Randomized to standard TRUS-guided biopsy vs. MRI and if MRI positive then standard biopsy with targeted biopsy'''
***If MRI negative, biopsies were not performed unless Stockholm3 test scores ≥25% or greater
** Primary outcome: proportion of males diagnosed with clinically significant cancer (Gleason score ≥7)
** Secondary outcome: proportion of males diagnosed with clinically insignificant cancers (Gleason score 6).
** Results
*** MRI non-inferior to diagnose clinically significant disease (21% MRI vs. 18% standard biopsy)
*** Significantly fewer clinically insignificant disease with MRI (4% MRI vs. 12% standard biopsy)
** [https://pubmed.ncbi.nlm.nih.gov/34237810/ Eklund, Martin, et al.] "MRI-targeted or standard biopsy in prostate cancer screening." ''New England Journal of Medicine'' (2021).