madman
Super Moderator
Screening and Prevention of Prostate Cancer 2021 (Part 3): Incorporating MRI for Early Detection – Summary:
In the final part of a 3-part series, Sigrid V. Carlsson, MD, Ph.D., MPH, Assistant Attending Epidemiologist at Memorial Sloan Kettering Cancer Center, considers the current role of MRI in the early detection of prostate cancer. She notes that while the various major prostate cancer guidelines recommend using multiparametric (mp)MRI before biopsy, they do not recommend using it as an initial screening tool. Also, while the EAU guidelines suggest that systematic biopsies can be omitted in patients with negative mpMRIs, the evidence for doing so is weak, and the NCCN guidelines take the more conservative approach of advocating for the inclusion of systematic biopsy with mpMRI. Dr. Carlsson continues by analyzing some of these limitations of mpMRI, explaining that its accuracy is highly dependent on the expertise of who is reading it. For this reason, it may be too early to omit biopsies in men with negative MRIs unless the MRI was performed at a specialized clinic. Furthermore, Dr. Carlsson notes, many of the studies showing the benefit of mpMRI were performed at centers of excellence, and may not reflect the limitations of most institutions. She opines that a chain is only as strong as its weakest link, and notes that pre-biopsy MRI requires access to high-quality mpMRI studies, optimal reading of scans, and access to high-quality mpMRI-targeted biopsy in order to truly be successful. Dr. Carlsson concludes by listing a variety of ongoing studies into imaging for prostate cancer screening and noting that evidence suggests unnecessary biopsies may be reduced in the future by combining mpMRI and different biomarker tests.
