Can MRI Replace Biopsy for Prostate Cancer Surveillance? Cost Implications and Patient Acceptance

Gerald Chodak, MD


May 09, 2017

Hello. I am Dr Gerald Chodak from Medscape. This week I want to talk about the use of multiparametric MRI for following prostate cancer patients who are on active surveillance. Habibian and coworkers[1] published a paper based on 200 men with prostate cancer whom they had been following with active surveillance; 114 of them had both an initial MRI and at least one follow-up MRI during the course of their management.

They have reported these results and found the following: 14 of the 114 men showed some new or changed abnormality on MRI. That included either worsening of a prominent lesion, a new lesion, or the suggestion of extracapsular disease. Of the 14 men in whom they found these changes, seven underwent a biopsy, and six of the seven did in fact show extracapsular disease. They are suggesting, based on their data, that multiparametric MRI might be an alternative way to follow men on a regular basis rather than doing routine biopsies.

Ultimately, that may prove to be a reasonable strategy, or some modification of this may be a reasonable strategy. There are a number of questions. For example, of the men who did not show changes on MRI, the authors did not report the results of biopsies in those men. We cannot say for sure whether the multiparametric MRI was missing a significant number of cases in which the cancers were indeed getting worse. The study could have been improved by presenting combined data—both the MRI data and, alongside that, biopsies in the men with changes on MRI and biopsies in the men who had no changes in the MRI.

We can ask ourselves the following question: Would doing multiparametric MRI make active surveillance more acceptable to patients? In other words, if they knew that they were simply getting an x-ray rather than a periodic biopsy, maybe they would find that more acceptable. Costwise, it would probably be more expensive. However, the cost is partly offset by the fact that men can avoid the complications associated with doing periodic routine biopsies. We will need more data to further assess that.

Maybe a strategy could evolve in which the multiparametric MRI is done annually, and then maybe every 3 or 5 years a biopsy is done. You lessen the routine use of biopsies and substitute the MRI for it. We will need more data as this continues to evolve. People are continuing to search for ways to improve the management and surveillance of men on active surveillance to make it more acceptable and also to make sure that we do not miss out on diagnosing a cancer before it becomes incurable. I look forward to your comments. Thank you.


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