MRI superior for PCa detection?

Actually, Johns Hopkins has been studying this and using their extensive biopsy database to come to certain conclusions.

What they recommend is an MRI targeted biopsy plus systemic samples from all the prostate regions. So, if you had three suspicious areas on the MRI, you would have one or two core samples from each of those areas, plus one core from each of the usual systemic template areas.

This is pretty normal. What JH found is that only sampling the MRI suspicious areas resulted in missing 15 percent of the significant >=G7 lesions elsewhere in the prostate.

Thanks for the clickable link.

ASAdvocate said...
This is pretty normal. What JH found is that only sampling the MRI suspicious areas resulted in missing 15 percent of the significant >=G7 lesions elsewhere in the prostate.

Did they comment on whether the “missed 15%” made any difference to the treatment protocol? In other words, were the suspicious areas just as bad as the missed areas so did not change the outcome or did they find worse conditions that were missed?

Just wondering, better MRI’s will be the key to limiting the scope of the biopsy someday which would be a good thing until a blood test can do it.

I think the most interesting thing about this is it’s a Meta study. It used data from 18 different studies. This minimizes the results of any one study by any one institution like JH and captures a wider sample.

From what i understand it suggests by using data from 18 studies the MRI path was better than the random biopsy and DRE path. This MRI path included both with and without an MRI informed biopsy.

So while not new new information, the MRI path appears to be the new gold standard. That’s not saying MRI guided and informed biopsies aren’t necessary and improve outcomes. But to me it indicates the path I endured which was 2, 12 part random biopsies that discovered nothing until i had the MRI fusion biopsy, is no longer the best path.

When life insurance company denied coverage based on PSA I specifically requested an MRI as the first step. Saw some articles referencing its usefulness in identifying clinically significant cancer and just felt like an obvious first step. I got my PCP to write a script and then found a place that did it. Armed with results it looked to me like I was highly likely to harbor something so then proceeded to biopsy. Biopsy results by MSKCC came up with G6 and they recommended AS. The MRI results plus some other data pushed me to seek additional opinions. In my case I am glad I put weight on the MRI but this is only one case.

My MRI was pretty clear for one lesion that even I could see, the second one is still a mystery to me but the radiologist could tell somehow. My Uro started with the targeted areas and finished up with standard 12 samples of which 40% were clear and the rest G6 and G7. Mine would have been caught just with the biopsy but the doctor might have let the biopsy go if nothing was on the MRI so it seems that both should be done until the MRI’s get better. I like the idea of one biopsy right in the middle of the lesion like they do for most other cancers someday rather than the shotgun approach currently employed.