MRI Plus New Score Halves Biopsy Rate for Prostate Cancer

MRI Plus New Score Halves Biopsy Rate for Prostate Cancer

medscape.com

MRI Plus New Score Halves Biopsy Rate for Prostate Cancer

Neil Osterweil
3-4 minutes

More good tidings to gladden the hearts of men who have reached the half century mark: Swapping traditional prostate biopsies for MRI-targeted biopsies with a new prostate cancer risk score can cut the number of unnecessary biopsies in half while still detecting clinically significant cancers.

The findings from the STHLM3MRI study, a large randomized trial, were published online in The New England Journal of Medicine to coincide with a presentation of the results at European Association of Urology 2021 Annual Meeting (EAU 2021).

The trial included nearly 2300 men with elevated prostate-specific antigen (PSA) levels and/or high scores on the Stockholm 3 predictive test.

They were randomly assigned to undergo either systematic biopsy or Stockholm 3 testing plus MRI with biopsy only of suspicious lesions.

The results show that the MRI-targeted strategy was associated with a 52% reduction in biopsy procedures compared with the systematic approach and a 69% reduction in detection of low-grade (Gleason score 6) cancers, reported Tobias Nordström, MD, PhD, from the Karolinska Institute, in Stockholm, Sweden.

"Combining the Stockholm 3 test with an MRI-targeted biopsy approach for prostate cancer screening decreases overdetection while maintaining detection of significant prostate cancer," he said at the meeting.

"It is exciting to see breakthroughs such as this in the field of early detection of prostate cancer. An innovation such as STHLM3MRI makes an even more compelling case for the European Commission to ensure a risk-stratified approach to early detection of prostate cancer is adopted across the whole of Europe," commented Hendrik Van Poppel, MD, PhD, adjunct secretary general of the EAU.

Although routine screening for breast and colorectal cancer is widely performed in Europe, to date, only Lithuania has established a nationwide program for prostate cancer screening, according to the EAU.

The Stockholm 3 test, developed at the Karolinska Institute, includes clinical variables (age and previous biopsy status) and a single-nucleotide-based genetic score, as well as measurements of five protein levels: total PSA, free PSA, human kallikrein 2, microseminoprotein-beta, and macrophage inhibitory cytokine 1.

MRI-Guided Biopsy Studies

Several recent major clinical trials have highlighted the advantages and potential drawbacks of MRI-targeted biopsy compared with transrectal ultrasound–guided 12-core systematic biopsy.

As previously reported by Medscape Medical News, the European PRECISION trial and its Canadian sister, the PRECISE trial, showed that an MRI-guided technique identified more clinically significant cancers and reduced the need for biopsy.

The new wrinkle introduced in STHLM3MRI trial is the addition of the Stockholm 3 score, which was added in an attempt to improve accuracy and reduce identification of clinically unimportant low-grade tumors.

The investigators invited 49,118 men aged 50 to 74 years to be screened; of these patients, 12,750 agreed. These men gave blood samples that were tested for PSA and Stockholm 3 parameters.

 

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