Prostate Cancer: Diagnosis and evaluation: Difference between revisions

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 *'''<span style="color:#ff0000">Randomized trials evaluating MRI in Prostate Cancer</span>'''
 **'''<span style="color:#ff00ff">PROMIS (2017)</span>'''
-*** '''<span style="color:#ff0000">Objective: evaluate sensitivity/specificity of mpMRI</span> vs. standard TRUS biopsy, with template prostate mapping biopsy as gold standard reference'''
+*** '''<span style="color:#ff0000">Objective: evaluate sensitivity/specificity of prostate MRI vs. standard TRUS biopsy,</span> with template prostate mapping biopsy as gold standard reference'''
-*** Population: 576 men with a clinical suspicion of prostate cancer (elevated serum PSA (up to 15 ng/mL) within previous 3 months, suspicious digital rectal examination, suspected organ confined stage T2 or lower on rectal examination, or family history)
+*** Population: 576 men with a clinical suspicion of prostate cancer (elevated serum PSA (up to 15 ng/mL) within previous 3 months, suspicious digital rectal examination, suspected organ confined stage T2 or lower on rectal examination, or family history) and no previous prostate biopsy
-*** '''Intervention: mpMRI followed by template prostate mapping biopsy as gold standard reference and then standard TRUS biopsy'''
+*** '''Intervention: prostate MRI followed by template prostate mapping biopsy as gold standard reference and then standard TRUS biopsy'''
-****Patients with positive mpMRI did not undergo targeted biopsy
+****MRI was done with 1.5 Tesla magnet
-*** Primary outcomes: sensitivity and specificity of mpMRI vs. standard TRUS biopsy
+****Patients with positive MRI did not undergo targeted biopsy
+*** Primary outcomes: sensitivity and specificity of prostate MRI vs. standard TRUS biopsy for detection of clinically significant prostate cancer
+****Clinically significant prostate cancer defined as Gleason score ≥4 + 3 or a maximum cancer core length 6 mm or longer
 ***'''<span style="color:#ff0000">Results:</span>'''
 **** '''<span style="color:#ff0000">mpMRI displayed a moderate sensitivity</span>''' (88%) and negative predictive value (76%), '''<span style="color:#ff0000">but poor specificity</span>''' (45%) and positive predictive value (65%).
+***Authors' interpretation: MP-MRI, used as a triage test before first prostate biopsy, could reduce unnecessary biopsies by ≈25% (based on negative-predictive value). 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/28110982/ Ahmed, Hashim U., et al.] "Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study." The Lancet 389.10071 (2017): 815-822.
 ** '''<span style="color:#ff00ff">PRECISION (2018)</span>'''