A Strategy to Reduce Unnecessary Prostate Biopsies

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If, based on initial screening results from a prostate-specific antigen (PSA) test or digital rectal exam (DRE), your doctor suspects you have prostate cancer, undergoing a magnetic resonance imaging (MRI) scan as your next step might spare you the medical risks of a prostate biopsy and improve your chances of an accurate diagnosis, say British researchers.

For the study, 576 men suspected of having prostate cancer had an MRI followed by a standard transrectal ultrasound (TRUS)-directed biopsy and, as a reference, a prostate-mapping biopsy. MRI identified nearly twice as many of the aggressive cancers as TRUS: 93 percent versus 48 percent, respectively. For nonaggressive cancers, however, the MRI missed 55 percent, while the TRUS biopsy missed just 1 percent. The authors estimate that having men with high PSA levels undergo an MRI before TRUS could allow more than one-quarter to avoid unnecessary biopsies. The results were reported in 2017 in The Lancet.

Our advice: If initial screening results suggest prostate cancer, get a follow-up evaluation that includes a DRE and a repeat PSA test and/or other blood tests (e.g., phi or 4K test) to determine whether you need a prostate biopsy. If the results suggest that a clinically significant prostate cancer may be present, you may want to consider getting an MRI scan to help inform and guide the prostate biopsy.