Making progress?

Top Line: Can serial MRI replace biopsy for men undergoing active surveillance for prostate cancer?

The Study: A practical challenge with active surveillance for prostate cancer is the need to perform serial biopsy to confirm disease status and rule out progression. Prostate biopsy is a key component of AS trials, so you can’t exactly expect the same outcomes while skipping out on the biopsy. That seems to be what happens in the real world, though. A population-based study from North Carolina recently showed that fewer than half of patients on AS have a repeat biopsy in the first 2 years and just 13% receive all guideline recommended surveillance tests. Have we reached a point where MRI could replace biopsy? This systematic review and meta-analysis evaluated the ability of serial MRI to detect progression during AS. It included 15 studies, 6 of which used the standardized PRECISE criteria for progression. Although MRI has become an effective diagnostic tool, it was not accurate enough when it came to detecting overall disease progression as it potentially missed 15-20% of disease progression. The pooled sensitivity, specificity, PPV, and NPV for progression were 0.59, 0.75, 0.5, and 0.85. However, MRI did seem effective at ruling out progression to grade group 3 (NPV 0.95)—analogous to its diagnostic detection of clinically significant disease.

TBL: Many men on AS for prostate cancer don’t undergo guideline-recommended serial biopsy, and serial MRI is not yet accurate enough at predicting progression to replace biopsy. | Chen, Int J Radiat Oncol Biol Phys 2021 and Rajwa, Euro Urol 2021