Saturday, February 10, 2018

Imaging-first strategy effective for prostate cancer

CANCER DIGEST – Feb. 9, 2018 – An advanced imaging technique is a cost-effective first test for the diagnosis of prostate cancer when followed by a combination imaging-guided biopsy say researchers.

The PROMIS study published in the January 2018 European Urology was designed to compare cost and effectiveness of three diagnostic strategies: transrectal ultrasound-guided biopsy (TRUSB), template prostate mapping biopsy (TPMB), and multiparametric magnetic resonance imaging (mpMRI) for the detection of clinically significant prostate cancer.

Multiparametric MRI uses a combination of MRI techniques to produced data about a suspicious lesion within the prostate that allows doctors judge whether a tumor is a clinically significant high-risk cancer or a relatively low-risk tumor that can be monitored. TRUS biopsy uses ultrasound to guide a needle biopsy of a suspicious lesion. Template prostate mapping biopsy (TPMB) uses MRI and prostate mapping to increase accuracy of biopsy.

The PROMIS study results showed that a strategy of using mpMRI first, followed with up to two biopsies guided by MRI data and ultrasound, was more effective and cost effective than the strategy of TRUS first.

In discussing preliminary findings of PROMIS at the American Urological Association’s meeting last year, co-author Dr. Mark Emberton of the University College Hospital in London proposed new imaging-based algorithm for diagnosis, treatment and follow-up for prostate cancer.

“The future may be that you’ll have an MRI with or without a PSA,” Emberton said, “and if you have a really tiny lesion we watch it, if it starts growing you treat it, and that is the way we treat kidney cancers. With a small renal cancer you watch, if it progresses, you treat it and increasingly we use ablative techniques to manage kidney cancers and obviously we have those in the prostate. So that’s the new pathway.”

MRI for diagnosing prostate cancer has been considered not cost-effective, but a similar study done by Case Western researchers published last year in the journal Radiology  found that the greater ability to stratify lesions by low-risk cancer that can by watched and high-risk cancer that should be treated makes this mpMRI approach cost effective.

In that study the researchers concluded that using MRI to help detect lesions and guide biopsies increased standardized quality-adjusted life years for patients and was cost-effective in 94.05% of simulations.

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