MRI-guided biopsies growing more common … but can we deal with the cost?

According to an article published on the Medscape Oncology web site earlier today, two paper presented at the European Congress of Radiology have provided further evidence of the potential of MRI-guided biopsies in the diagnosis of prostate cancer.

For those who are signed up to enter the Medscape web site, you can just click here to read the complete article. (There is no charge to become a Medscape member.)

The European Congress of Radiology has been taking place in Vienna, Austria over the past 5 days. The two papers referred to in the Medscape article were reported as abstracts 0171 and 0172 in the abstracts book for the Congress.

Basically, the first of the two papers (by Polanec et al., #0171) showed that combining multiparametric MRI scanning with MRI-guided biopsy is feasible and was capable of highly accurate diagnosis of prostate cancer in 11/41 patients (26.8 percent) with an average age of 65 years (range 44 to 75 years) and a mean PSA level of 8.17 ng/ml (range 0.7 to 30.3 ng/ml). Nine of the prostate cancers were found in the peripheral zone of the prostate. The other two cases were found in the transition zone (n = 1) and the central zone (n = 1). The Gleason scores of these 11 patients were 6 (in five patients), 7 (in four patients), 8 (in one patient), and 9 (again in one patient).

All the patients in this study were followed for 2 to 61 months after biopsy. No new cases of prostate cancer were diagnosed in these 41 patients during follow-up. In other words, 30/41 patients (73.2 percent) appear to have been prostate cancer-negative, implying that this combination of MRI scans and MRI-guided biopsy is capable of obviating false-negative biopsies in the diagnosis of prostate cancer.

The second of the two papers (by Franiel et al., #0172) set out to evaluate the acceptance, adverse effects, and complications of MRI-guided prostate biopsy as compared to transrectal ultrasound (TRUS)-guided biopsy.

This study enrolled 54 patients with persistently elevated PSA levels and high suspicion for prostate cancer. All patients had had at least one negative TRUS-guided biopsy. They were all given an initial MRI and then underwent an MRI-guided biopsy, with between one and nine biopsy cores being taken.

One week after the outpatient MRI-gided biopsy, the patients were asked to respond to a telephonic survey.

Basically, Franiel et al. found that:

  • MRI-guided biopsy was preferred over TRUS-guided biopsy by 35/54 patients  (64.8 percent).
  • 44/54 patients (81.5 percent) stated that they would be willing to undergo MRI-guided biopsy again in the future.
  • Pain intensity and duration of bleeding were significantly lower for MRI-guided as compared with TRUS-guided biopsies (p < 0.01).
  • Blood in the urine (hematuria) was the most common side effect of both biopsy methods
    • In 59 percent of patients after an MRI-guided biopsy
    • In 80 percent of patients after a TRUS-guided biopsy.
  • Other complications of MRI-guided biopsy were arterial bleeding (n = 1) and infection with fever (n = 1).
  • Other complications of TRUS-gided biopsy were epididymitis (n = 1) and infection with fever (n = 2).
The authors of the second paper concluded that patients prefer MRI-guided to TRUS-guided prostate biopsies because of the lower pain intensity and fewer side effects. They go on to suggests that “MRI-guided biopsy is a suitable option for patients with persistent suspicion of prostate cancer” after prior, negative TRUS-guided biopsy.
There appears to be little doubt that MRI-guided biopsies are becoming increasingly common; that they are accurate in the diagnosis of prostate cancer; and that they are potentially more acceptable to patients. What does worry The “New” Prostate Cancer InfoLink is the cost associated with millions of negative MRI-guided biopsies being carried out in the USA each year. This is not a low-cost option here in the USA.
Commenting on this work himself, Dr. Polanec is reported as stating that, “While I don’t think MR-guided biopsy will replace the transrectal approach, if I were a patient, I would prefer doing the multiparametric MRI in combination with MR-guided biopsy because you reduce the number of cores you need and it’s just more comfortable.”

4 Responses

  1. Interesting. Although if MRI becomes a widely used diagnostic (even more so than now), how will supply meet demand? Waiting times for MRI are lengthy and acquisition is not straightforward. It would be interesting to see if optical techniques or ultrasound could fill this gap, particularly in light of the toxicity of gadolinium-based contrast agents

  2. if a 3 Tesla MRI can locate prostate cancer, why not go directly to HIFU and bypass the MRI guided biopsy?

  3. Because a 3 T MRI can not locate prostate cancer with 100% accuracy, any more than a biopsy can. MRI scans of various types (including scans using more standard 1.5 T MRI systems) can identify suspicious lesions in the prostate, but a biopsy is still necessary to confirm prostate cancer. Furthermore, even 3 T MRI scans cannot identify some small prostate cancer lesions.

  4. In your June 15, 2013, review of MRI-guided biopsies in Britain, mention is made that one of the disadvantages of MRI-guided biopsies is that they require anesthesia to keep the patient from moving during the biopsy procedure.

    I do not think that anesthesia is utilized except for some rare light sedation with the MRI-guided prostate biopsy, either fusion or in-scanner type in the US.

    This comment is being made so as to not discourage people from having an MRI-guided prostate biopsy, if that is what they think they need.

    Of course, peritoneal or saturation biopsies do require general anesthesia, and that is one of the reasons people do not perform them regularly. Perhaps there was confusion between these two types of prostate biopsy in the article mentioned.

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