1: mpMRI before biopsy could spare a quarter of men from biopsy and improves detection of significant cancer
The long awaited publication of the PROMIS trial confirmed results announced at ASCO in June last year: multi-parametric MRI (mpMRI or MP-MRI) is a robust diagnostic tool and can be used to effectively triage men. The multi-centred study published in The Lancet involved 576 men and compared mpMRI to standard of care TRUS biopsy (12 cores) and gold standard template mapping biopsy (60-70 cores). mpMRI had a sensitivity of 93% compared to 48% for TRUS, meaning it is almost twice as likely to detect clinically significant cancer (Gleason ≥ 4+3 or core length ≥6mm). One of the strengths of mpMRI is that it does not detect clinically insignificant cancer and therefore could reduce biopsies by 27%. In addition, if mpMRI images are used to target biopsies, it could reduce over-detection of clinically insignificant cancer by 21% and increase detection of significant cancer by 18%. As the specificity of mpMRI alone is only 41%, biopsy is still required to confirm a diagnosis of prostate cancer. We are working with health bodies across the UK to ensure that we have not only enough scanners but the appropriate training and reporting standards in place in order to increase the number of men who have access to high-quality mpMRI before biopsy. Read more about our work on mpMRI here.