MP26-06 EFFECTS OF MAGNETIC RESONANCE IMAGING TARGETING ON OVERDIAGNOSIS AND OVERTREATMENT OF PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening II (MP26)1 Sep 2021MP26-06 EFFECTS OF MAGNETIC RESONANCE IMAGING TARGETING ON OVERDIAGNOSIS AND OVERTREATMENT OF PROSTATE CANCER Andrew Vickers Andrew VickersAndrew Vickers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002023.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It has been suggested that targeting prostate lesions identified on magnetic resonance imaging (MRI) will improve the sensitivity of prostate biopsy for high-grade disease. The clinical significance of high-grade tumors found by MRI-targeting in men with benign systematic biopsy findings is open to question. We compared data from the National Cancer Institute (NCI) study of MRI-targeted biopsy with results from long-term follow-up of men who had negative sextant biopsy in the European Randomized trial of Screening for Prostate Cancer (ERSPC) METHODS: The NCI study included finding from MRI-targeted biopsy for 999 men with negative systematic biopsy. For ERSPC, 3,056 men who had negative sextant biopsy were followed for 11 years. We calculated the number of patients needing to be diagnosed (NND) and treated (NNT) following targeted biopsy in order to prevent one prostate cancer death at 11 years. We used a simple modelling approach that involved several assumptions, such as the proportion of the deaths in the ERSPC would have been prevented by earlier diagnosis had the initial biopsy been MRI-guided. We then varied these assumptions to assess the effects on the results. RESULTS: In the base scenario, which involved assumptions favorable to MRI, NND and NNT were 89 and 57 (table). Results were only more encouraging for MRI-targeting under unlikely scenarios, such as 100% sensitivity for MRI and 100% cure rates for treatment. CONCLUSIONS: Although MRI may be of benefit overall, considering decreases in overdiagnosis resulting from avoidance of biopsy in men with negative scans, targeting biopsy needles to MRI-detected lesions results in a large number of men diagnosed and treated per death prevented. Consideration should be given to changing guidelines on grading of MRI cores and those regarding treatment of high-grade prostate cancer. Source of Funding: This work was supported in part by the National Institutes of Health/National Cancer Institute (NIH/NCI) with a Cancer Center Support Grant to Memorial Sloan Kettering Cancer Center [P30 CA008748], a SPORE grant in Prostate Cancer to Dr. H. Scher [P50-CA92629], the Sidney Kimmel Center for Prostate and Urologic Cancers and David H. Koch through the Prostate Cancer Foundation. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e464-e464 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Vickers More articles by this author Expand All Advertisement Loading ...