There are various methods for detecting prostate cancer early. The initial step commonly involves a blood test measuring prostate-specific antigen (PSA). If the PSA levels are higher than a specified limit, the next procedure generally includes taking a tissue sample for further examination. Alternatively, magnetic resonance imaging (MRI) can be utilized to identify any potential tumors before deciding if a biopsy is required, limiting biopsies to cases where anomalies are found. A study conducted by researchers at Charité — Universitätsmedizin Berlin aimed to assess the long-term safety of the MRI-first strategy. Their results indicate that this approach does not add any risk to patients for at least three years. The findings have been published in the journal JAMA Oncology.
The traditional method for diagnosing prostate cancer involves a clinical assessment and PSA testing. The PSA test checks the levels of this protein in the blood, as elevated levels can hint at prostate cancer, although they can also arise from benign conditions. Historically, high PSA readings have led to a punch biopsy, where ten to twelve tissue samples are systematically collected from the prostate. This procedure often causes uncomfortable side effects for several days and carries a certain risk of infection. Furthermore, PSA-guided “blind” biopsies frequently contribute to the overdiagnosis of indolent, clinically insignificant cancers while risking the failure to identify more aggressive forms of the disease.
“These side effects from systematic biopsies pushed us to investigate if MRI could be a dependable and safe tool for making biopsy decisions in men suspected of having prostate cancer, and whether men with normal MRI results could safely defer immediate biopsy and transition to clinical follow-up,” explains Dr. Charlie Hamm, the primary author of the study and a physician at the Department of Radiology at Charité, as well as a Junior Digital Clinician Scientist at the Berlin Institute of Health at Charité (BIH).
No Need for a Biopsy with Negative MRI Results
This method, where standard MRI outcomes are followed by regular urological evaluations, proved to be reliable: The study revealed that 96 percent of patients with normal MRI results did not develop aggressive prostate cancer within a three-year period. Only four percent of participants with initially negative MRI findings were diagnosed with aggressive cancer later during the monitoring process.
“This indicates that the cancer risk is minimal when MRI scans do not indicate anything suspicious,” says Dr. Hamm. “While normal MRI results do not guarantee complete certainty, regular check-ups allow for the early detection of potential cancers. For many patients, this means they can initially bypass the discomfort associated with biopsies and avoid the anxiety of undiagnosed cancer.”
Monitoring Is Adequate for Early Cancer Detection
The research team included and observed nearly 600 patients suspected of having prostate cancer. Each participant underwent multiparametric magnetic resonance imaging (mpMRI) at Charité. This advanced MRI technique assesses multiple tissue-specific parameters, such as the signal intensity of prostate tissue, blood flow, or perfusion, and the diffusion of water molecules within the tissue. A skilled team of radiologists analyzed the images. “Tissue samples were collected only when the MRI indicated suspicious findings in the prostate. Patients with normal MRI results instead had regular urological evaluations over three years. This setup allowed us to determine the safety of the MRI approach,” explains Dr. Hamm regarding the study design.
High-Quality MRI Findings and Safety Measures Are Essential
After eight years, the study has been concluded. “Our findings represent a significant advancement toward personalized care for prostate cancer patients. By employing MRI for biopsy decision-making, we can ensure that patients receive appropriate tests and treatments promptly,” states Dr. Hamm.
The results are also crucial for physicians as they guide patients on whether a biopsy is genuinely necessary. The European Association of Urology (EAU) guidelines already suggest that an MRI should precede a prostate biopsy. However, it was previously uncertain how safe it would be to omit the biopsy entirely when MRI results are negative. “Our findings establish that the MRI approach is both safe and effective, even within a decentralized outpatient care framework,” remarks Dr. Hamm. “We hope that this study will motivate further improvements in the role of MRI as a tool for deciding on a biopsy in both the German guidelines and beyond.”
Nonetheless, the authors emphasize two critical aspects that need consideration for the new findings to be implemented in practice quickly. First, a high-quality MRI scan must be performed and evaluated by skilled professionals; this entails training more radiologists in accurately interpreting prostate MRI scans and employing standardized techniques. Second, establishing a safety framework for patients who do not receive immediate biopsies is vital. “This means creating clear guidelines for PSA testing, follow-up MRIs, and criteria indicating when a biopsy may be warranted later,” Dr. Hamm notes.
About the Study
The study was conducted through collaboration between private practice urologists in Berlin and the Department of Radiology at Charité. External physicians participated in developing the study’s concept as well as in recruiting and monitoring patients throughout their treatment. Funding sources for this study include local cancer organization Berliner Krebsgesellschaft e.V., radiology association Berliner Röntgengesellschaft — Röntgenvereinigung zu Berlin und Brandenburg e.V., and urology association Berliner Urologische Gesellschaft e.V.
