A study published in The Lancet shows that using advanced MRI almost doubles the number of aggressive tumours detected. 

This news follows the announcement of MRI scanning being twice as likely to detect prostate cancer than biopsy.

In the study, using MP-MRI scans to guide biopsies detected 93% of clinically significant cancers, compared to just 48% detected with a TRUS-biopsy.

By increasing the accuracy with which the prostate can be imaged, and cancerous lesions mapped, treatment can subsequently become significantly more targeted.

In the paper, entitled ‘Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study’, the authors state the "Multi-parametric magnetic resonance imaging (MP-MRI), used as a triage test before first prostate biopsy, could identify a quarter of men who might safely avoid an unnecessary biopsy and might improve the detection of clinically significant cancer."

Typically, men undergo a biopsy of their prostate if they experience symptoms of prostate cancer or have a prostate specific antigen (PSA) test showing high levels of the PSA protein in their blood.

Each year, over 100,000 prostate biopsies are carried out in the UK and one million are conducted in Europe.

However, the PSA test is not always accurate, which means that many men undergo unnecessary biopsies.

"Prostate cancer has aggressive and harmless forms. Our current biopsy test can be inaccurate because the tissue samples are taken at random. This means it cannot confirm whether a cancer is aggressive or not and can miss aggressive cancers that are actually there. Because of this some men with no cancer or harmless cancers are sometimes given the wrong diagnosis and are then treated even though this offers no survival benefit and can often cause side effects. On top of these errors in diagnosis, the current biopsy test can cause side effects such as bleeding, pain and serious infections." said lead author, Dr Hashim Ahmed, UCL, UK.

"Our results show that MP-MRI should be used before biopsy. Our study found that using the two tests could reduce over-diagnosis of harmless cancers by 5%, prevent one in four men having an unnecessary biopsy, and improve the detection of aggressive cancers from 48% to 93%," said Dr Hashim Ahmed. "While combining the two tests gives better results than biopsy alone, this is still not 100% accurate so it would be important that men would still be monitored after their MP-MRI scan. Biopsies will still be needed if an MP-MRI scan shows suspected cancer too, but the scan could help to guide the biopsy so that fewer and better biopsies are taken."

Source: The Lancet