News | Magnetic Resonance Imaging (MRI) | February 08, 2021

Using MRI for Prostate Cancer Diagnosis Equals or Beats Current Standard

Phase III clinical trial of men with a clinical suspicion of prostate cancer finds MRI with targeted biopsies to be more accurate at diagnosis and less intrusive than current standard

Phase III clinical trial of men with a clinical suspicion of prostate cancer finds MRI with targeted biopsies to be more accurate at diagnosis and less intrusive than current standard

February 8, 2021 — The results of a Phase III randomized clinical trial have shown that when it comes to detecting clinically significant prostate cancer, magnetic resonance imaging (MRI) with targeted biopsies (MRI-TBx) matches the current standard and brings a multitude of advantages. The PRostate Evaluation for Clinically Important Disease: MRI vs Standard Evaluation Procedures (PRECISE) study will help to make prostate cancer diagnosis more accurate and less invasive.

PRECISE included 453 participants at Canadian academic cancer centres who were either assigned to receive MRI imaging followed by MRI-TBx of suspicious areas (identified by MRI), or the current standard of care of a systematic 12-core transrectal ultrasound-guided (TRUS) biopsy (TRUS-Bx).

Key findings:

  • MRI with targeted biopsy found five per cent more clinically significant prostate cancers compared to those receiving systematic TRUS-Bx biopsies, conclusively demonstrating the method can at least match the performance of the current standard of care.
  • Compared to standard TRUS-Bx, the MRI-TBx were found to be better in identifying clinically significant cancers.
  • More than a third of patients in the MRI arm of the trial avoided biopsies altogether following negative imaging results. Those individuals received a follow-up MRI in two years' time.
  • Those who did have biopsies in the MRI arm had significantly fewer samples taken when compared to systematic TRUS-Bx, resulting in less pain and discomfort for patients. Moreover, the MRI arm had a decreased adverse event profile, including less hematuria (blood in the urine) and incontinence.
  • There is a major unmet need for a test that identifies clinically significant prostate cancer while avoiding overdiagnosing clinically insignificant cancers. Use of MRI reduced the unnecessary diagnosis of slow growing, clinically insignificant prostate cancers by 55 per cent.

These findings show decisively that MRI together with targeted biopsies offer patients a less invasive procedure, the chance to avoid a biopsy all together and can help avoid the over-treatment of clinically insignificant prostate cancer - all while detecting a higher rate of clinically significant cancers.

"My colleagues and I are thrilled about these results that show, without a doubt, that imaging and targeted biopsies are the future of prostate cancer diagnosis. We can catch more of the cancers we should be treating, avoid unnecessary treatment at the same time and improve the quality of life for our patients." said Laurence Klotz, M.D., Chair of Prostate Cancer Research at Sunnybrook Health Sciences Centre and lead author of the study. "We thank the study participants and our funders for their support and look forward to continuing our efforts to have this technology used more widely."

"The study's findings have influenced Ontario Health-Cancer Care Ontario's upcoming, updated Prostate MRI Guidelines, which will be released this year," said Masoom Haider, M.D., co-lead of the study and Professor of Medical Imaging at the University of Toronto, and Clinician Scientist with the Ontario Institute for Cancer Research. "I am pleased to see our research produce results that will make a real difference in how prostate cancer is diagnosed and improve the lives of patients."

"I congratulate Dr. Klotz and the PRECISE team on this truly impactful research which will change clinical care and make a difference for men with prostate cancer," said Christine Williams, M.D., Deputy Director and Head, Clinical Translation at the Ontario Institute for Cancer Research. "It is a great example of how, with our partners, we are moving research innovations to the clinic to improve the lives of patients and treat cancer with improved precision."

"These practice-changing results will have a significant and positive impact on the roughly 64 Canadians who are diagnosed with prostate cancer every day. Thanks to the efforts of Dr. Klotz and his team, people will need to undergo fewer biopsies and for some of them, they will be spared from unnecessary biopsies and treatments altogether," said Stuart Edmonds, M.D., Executive Vice President, Mission, Research and Advocacy at the Canadian Cancer Society. "We are proud to support this research, which will help people with prostate cancer live longer, fuller lives."

"At Movember, we are honoured to play a role in funding cutting-edge research like the PRECISE study, ultimately helping to provide more positive outcomes for men living with or beyond a prostate cancer diagnosis," said Todd Minerson, Country Director for Movember Canada.

For more information: www.oicr.on.ca

Related Content

Chart courtesy of the American Cancer Society

News | Breast Imaging | February 08, 2021
February 8, 2021 — Cancer ranks as a leading cause of death in every country in the world, and, for the first time,

Images in 69-year-old man with biopsy-confirmed Gleason score 7 (3+4) prostate cancer. (a) Pretreatment axial T2-weighted fast spin-echo MRI scan (repetition time msec/echo time msec, 3820/97) shows tumor in midline anterior transition zone (arrow). (b) Intraoperative MRI scan shows contoured rectal wall (red line), prostate margin (blue outline), and region of interest (orange outline). Because the urethra was included in planned treatment volume, a suprapubic catheter was placed for continuous bladder drainage during treatment. (c) Intraoperative MRI scan shows focused ultrasound beam path (blue) overlaid on treatment plan. Rectangles illustrate each sonication spot. (d) Thermal map image obtained during treatment with heat deposition color coded in red overlaid on sonication spot. (e) Axial gadopentetate dimeglumine-enhanced MRI scan (230/2.97) obtained immediately after treatment shows devascularized ablated volume (arrows). (f) Corresponding T2-weighted fast spin-echo MRI scan (3820/97) at 5 months after ablation shows complete involution of transition zone. All seven cores from treatment area margins were negative for cancer at biopsy. Image courtesy of the Radiological Society of North America

News | Prostate Cancer | February 05, 2021
February 5, 2021 — A technique that delivers...
Real Time Imaging Technologies LLC iannounced that it has received U.S. Patent No. 10,898,070 IMAGING APPARATUS AND METHODS which covers the company’s methods for incorporating microlens into X-ray imaging detectors that enables significantly lower radiation dose without compromising image resolution.

Getty Images

News | Radiation Dose Management | February 05, 2021
February 5, 2021 — 
Bright spots indicate that cancer cells have responded to a one-day challenge with estrogen in this positron emission tomography (PET) scan of a woman with breast cancer. In a small study, researchers at Washington University School of Medicine in St. Louis found that only women whose tumors responded to estrogen challenge benefited from hormone therapy. The findings could help doctors choose the treatments most likely to help their patients. Image courtesy of Farrokh Dehdashti

Bright spots indicate that cancer cells have responded to a one-day challenge with estrogen in this positron emission tomography (PET) scan of a woman with breast cancer. In a small study, researchers at Washington University School of Medicine in St. Louis found that only women whose tumors responded to estrogen challenge benefited from hormone therapy. The findings could help doctors choose the treatments most likely to help their patients. Image courtesy of Farrokh Dehdashti

News | PET Imaging | February 03, 2021
February 3, 2021 — Hormone therapy commonly is given as a targeted treatment for women whose cancer cells carry recep
Kaplan–Meier curves for the high-risk individuals and the ones with low or medium risk according to AI-severity. The threshold to assign individuals into a high-risk group was the 2/3 quantile of the AI-severity score computed for patients of the KB development cohort. a Kaplan–Meier curves were obtained for the 150 leftover KB patients from the development cohort. b Kaplan–Meier curves were obtained for the 135 patients of the IGR validation cohort. p-values for the log-rank test were equal to 4.77e–07 (KB

Kaplan–Meier curves for the high-risk individuals and the ones with low or medium risk according to AI-severity. The threshold to assign individuals into a high-risk group was the 2/3 quantile of the AI-severity score computed for patients of the KB development cohort. a Kaplan–Meier curves were obtained for the 150 leftover KB patients from the development cohort. b Kaplan–Meier curves were obtained for the 135 patients of the IGR validation cohort. p-values for the log-rank test were equal to 4.77e–07 (KB) and 4.00e–12 (IGR). The two terciles used to determine threshold values for low-, medium-, and high-risk groups were equal to 0.187 and 0.375. Diamonds correspond to censoring of patients who were still hospitalized at the time when data ceased to be updated. The bands correspond to the sequence of the 95% confidence intervals of the survival probabilities for each day. KB Kremlin-Bicêtre hospital, IGR Institut Gustave Roussy hospital. Courtesy of Nature Communications.

News | Coronavirus (COVID-19) | February 01, 2021
February 1, 2021 — COVID-19...

Beckman researcher, Brad Sutton (Photo courtesy the Beckman Institute)

News | Magnetic Resonance Imaging (MRI) | February 01, 2021
February 1, 2021 — Researchers at the Beckman Institute for Ad...