Combining MRI with PSA can avoid unnecessary biopsies

CANCER DIGEST – April 1, 2024 – An MRI of the prostate combined with a PSA test can determine clinically significant prostate cancer, according to results of new analysis of data.

Published in the the March 29, 2024 JAMA Network Open, the study by researchers at Brigham and Women’s Hospital and Mass General Brigham Healthcare System suggests that patients can avoid unnecessary prostate biopsies using the combination imaging and blood test.

The study was a meta-analysis of data from 72 previously published studies involving 36,000 patients. Lead authors Arya Haj-Mirzaian, MD, PhD, and Kristine Burk, MD used the rating scores used in MRI reports, known as prostate imaging reporting and data system (PI-RADS) scores, combined with prostate-specific antigen density (PSAD) scores.

PI-RADS scores rate lesions on a scale of 1 to 5 with 1 being highly unlikely to be cancer to 5, highly likely to be clinically significant cancer. PSAD is the PSA blood level divided by the prostate’s volume as determined by the MRI.

The researchers found that prostate biopsies may be unnecessary for patients with PI-RADS under 4 and PSADs below 0.10ng/ml2. And by using specific PI-RADS and PSAD cutoffs, doctors could confidently skip 50 percent of biopsies and miss 5 percent of clinically significant cancers, or they could skip 30 percent of biopsies and miss only 3 percent of clinically significant cancers.

"These data give us the confidence to say that in some cases, we can safely follow men with testing rather than aggressively pursue a biopsy in all cases," Adam Kibel, MD, chair of the Department of Urology said in a press release. "By making this information available to physicians and patients, we can help them make more informed decisions about undergoing biopsy."

The next step in the research is to develop a patient-friendly scoring system that urologists can use to evaluate a patient’s need for biopsy.

Source: Brigham and Women’s Hospital press release