The decision for precision.

Top Line: The PRECISION trial suggested MRI-targeted prostate biopsies are better than the standard 12-core approach in detecting clinically-significant prostate cancer (csPC) of at least Gleason 3+4, but some argue doing them both is best of all.
The Study: The aptly-named MRI-FIRST trial enrolled 251 men referred for prostate biopsy without a PSA >20 nor palpable extracapsular extension. And, you guessed it, everyone underwent diagnostic prostate MRI first. Where this differs from PRECISION is that everyone then received standard 12-core biopsies, and only those with suspicious MRI findings received sequential targeted biopsies. “Suspicious” was defined as a Likert score ≥3, i.e. using a more gestalt-y version of PIRADS. Among the 206 (82%) patients with a suspicious MRI, 8 were found to have csPC only upon 12-core biopsy yielding a targeted-biopsy false-negative rate of 6% (8 of 125 negative results). Of the 45 patients without a suspicious MRI, another 5 were found to have csPC upon 12-core biopsy yielding a diagnostic MRI false-negative rate of 11%. Taken together, the PRECISION approach of MRI first followed by targeted biopsy when suspicious yielded a false-negative rate of 8% (13 of 170 negative diagnostic MRIs and/or targeted biopsies). Finally, when considering number of biopsies needed to detect one csPC, 810 targeted biopsies detected 81 csPC (number needed = 10) while the additional 3070 biopsies using the 12-core approach detected an additional 13 csPC (number needed = 236).
Bottom Line: Unsurprisingly (a few) more clinically-significant prostate cancers were detected with (substantially) more biopsies, and while the authors conclude both techniques are needed, the clinical utility of this lies in the prostate of the beholder. | Rouvière, Lancet Oncol 2018

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  1. The information you have provided is very helpful at all thank you very much for sharing useful information with us. It is so nice to read about another woman going through it too!
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