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Recently, a Swedish study of more than 12,000 men was published in the New England Journal of Medicine (NEJM) showing clear benefits to magnetic resonance imaging (MRI)-targeted biopsies over standard biopsies for the detection of prostate cancer. VCU Health is one of a few large academic medical centers in the country that specializes in this advanced diagnostic imaging technique, so we asked Jinxing Yu, M.D., director of oncologic and prostate imaging in the Department of Radiology at VCU Health and Massey Cancer Center, to comment on the study and explain the procedure and its benefits.

What is an MRI-targeted prostate biopsy and how does it compare to the standard approach?

If someone is suspected of having prostate cancer, either through blood tests showing elevated prostate specific antigen (PSA) levels or nodular prostate by digital rectal examination, they often will undergo a biopsy to determine if cancer is present. A biopsy is the removal of a small amount of tissue so a pathologist can examine it for the presence of cancer.

Most often, men undergo a procedure known as a TRUS (transrectal ultrasound) guided prostate biopsy. This uses ultrasound to locate the prostate and then multiple tissue samples (as many as 12) are taken from different regions of the prostate and inspected for cancer. MRI machines produce very detailed pictures of the prostate and other organs. With an MRI biopsy, we first identify the precise location of the tumor and then perform the biopsy.

It’s not uncommon for men to undergo multiple TRUS biopsies before cancer is detected. Using our advanced MRI technologies, we’re able to make a diagnosis with more than 90 percent accuracy. We are also able to determine the severity of the tumor, which helps determine the best course of treatment and avoid overtreatment.

Jinxing Yu, M.D., director of oncologic and prostate imaging in the Department of Radiology at VCU Health and Massey Cancer Center

What were the results of the Swedish study?

This was a multi-institutional study that recruited 12,750 men 50-74 years of age to undergo prostate cancer screening using a PSA blood test. 1,532 participants showed PSA levels indicating possible cancer, and they were randomly assigned to undergo either a standard biopsy or an MRI-targeted biopsy if the MRI is positive for tumor. If the prostate MRI was normal, it was safe not to do a biopsy.

The study showed that MRI-targeted biopsies were as effective as standard biopsies in detecting clinically significant cancers and also reduced the detection of clinically insignificant cancers, which reduced unnecessary treatments.

Why is this study important?

There is a lot of debate about the effectiveness and benefits of screening for prostate cancer. Sometimes, prostate cancer can be a slow growing disease where curative treatment does more harm than good. However, prostate cancer can be aggressive and it disproportionately impacts certain groups such as Black men. This study showed that MRI-targeted biopsies have clear benefit in reducing the detection of clinically insignificant cancers than TRUS biopsies do.

It’s important to find a screening approach that accurately detects cancer while avoiding overtreatment. Removing the prostate sometimes leads to side effects such as impotency or loss of bladder control. MRI-targeted biopsies allow doctors to better diagnose prostate cancers so they might be able to employ alternative strategies for less aggressive tumors such as active surveillance.

Are you surprised by these results?

No, but I am glad to see them affirmed by a large comparative study. I am particularly happy to learn that the study has confirmed that if the patient’s prostate MRI is negative, it is safe not to perform a biopsy on the patient. This result will save many unnecessary prostate biopsies every year. We have been performing MRI-targeted biopsies for prostate cancer since 2011 at VCU Health and we know that MRI-targeted biopsies offer significant benefits over standard prostate biopsies.

Why don’t more places offer MRI-targeted biopsies for prostate cancer?

Many hospitals are able to perform MRI scans of the prostate, but the problem is that there are not enough radiologists who specialize in reading these scans. Data has shown that radiologists who specialize in one part of the body such as the lungs, breasts or prostate are much more accurate at diagnosing cancer simply because of the volume and experience that comes along with that specialization.

To biopsy the prostate using MRI targeting, you need a radiologist who specializes in reading prostate scans and you also need special equipment which will allow you to do image-guided biopsy procedure.

How is VCU unique in our use of MRI-targeted biopsies for prostate cancer?

In 2014, VCU Health invested in magnetic resonance/ultrasound fusion biopsy equipment after almost 4 years of in-Bore MRI guided prostate biopsy. This technology allows us to overlay MRI scans with real-time ultrasound images to precisely guide the biopsy needle to the tumor. The procedure only takes about 20 minutes, which is much faster than in-Bore MRI-targeted biopsy in which the patient must come out and go into the MRI machine multiple times during the procedure.

In addition to many brand new most advanced 3T MR machines, VCU Health has specialized GU radiologists in reading prostate MRI who also perform MRI-targeted biopsies, which is unique in Virginia and even in the country.

Who benefits most from this approach?

Men with a history of elevated PSA with or without prior TRUS biopsies should consider a prostate MRI and then possible MRI-targeted biopsy if the MRI is positive. These men are at risk of cancer spreading to other organs if their cancer is not accurately diagnosed and treated. At the same time, if the MRI is negative, it is safe not to perform a biopsy on him. This will allow many men to avoid unnecessary interventions.

How do I find out more or make an appointment?

If you’d like to learn more about MRI-targeted prostate biopsies at VCU Health or make an appointment, call (804) 628-9810.

Written by: John Wallace