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Each year, in the United States, one million men undergo biopsies to determine whether or not they have prostate cancer. The biopsy procedure has traditionally been guided by ultrasound, but this method does not clearly show the location of tumors in the prostate.
A multidisciplinary team of UCLA physicians has discovered that a new method, which includes magnetic resonance imaging or MRI guided biopsy, can be used with the traditional method to increase the detection rate of cancer. prostate.
Ultrasound was used to visualize the prostate in order to sample a representative sample of tissue until biopsy. The introduction of MRI has allowed doctors to see specific lesions in the prostate and to take only tissue samples. But the two sampling methods are often not used in combination.
In the three-year study published in JAMA Surgery, a strategy combining the two methods of sampling has detected up to 33% more cancers compared to standard methods. According to Dr. Leonard Marks, lead author, these findings could contribute to a significant change in the way prostate biopsies are performed.
Our research suggests that different biopsy methods identify different tumors. To maximize our ability to identify prostate cancer, we need to take advantage of all the information we can. Our cancer detection rate, while using different methods in tandem, exceeds that of using one or the other method. In this case, one plus one equals three. "
Marks, Jean B. deKernion Chair in the Department of Urology at David Geffen School of Medicine at UCLA
The study is the first to directly compare different biopsy sampling methods in the same group of men. Previous research had demonstrated the benefits of MRI guided biopsy, but the way to use new technology was unclear. This trial establishes that systematic and targeted lesion sampling is required to maximize the accuracy of prostate biopsy.
Over the last decade, MRI-guided biopsy methods, which are more targeted because they can accurately indicate the location of lesions in the prostate, have been used more commonly. However, some tumors are not visible as lesions on MRI, so these cancers may not be detected.
In the study of 300 people, 248 men had visible prostate lesion on MRI. Using all the information and biopsy methods available, the researchers detected cancer in 70% of men. Fifty-two other men participating in the trial had no lesions visible at the MRI; however, 15% of these men had cancer through the traditional method of ultrasound, confirming that MRI did not identify all tumors.
"Men evaluated for prostate cancer should first receive an MRI before biopsy," said Marks, a member of UCLA's Jonsson Comprehensive Cancer Treatment Center. "When there is a lesion on MRI, doctors should conduct systematic and targeted biopsies together to find cancer.Although MRI is negative for lesions, men at risk -; including those with high levels of prostate-specific antigen, prostate nodule, or family history – should always be the subject of a systematic and systematic biopsy. "
Identifying the precise location of cancer tissue in the prostate is particularly important as treatments become more and more targeted. While surgical removal of the entire gland, called prostatectomy, is a common treatment method, emerging therapies such as focal therapy aim to eliminate only the cancerous tissue from the gland while sparing healthy tissue.
"Improving our ability to see the location of cancer in the prostate in real time opens the door to therapeutic innovations," said Dr. Marks. "If we can identify the location of the tumors and place the biopsy needles directly there, why not find a way to destroy the tumor on the spot?"
Source:
UCLA
Journal reference:
Brands, L.S. et al. (2019) Comparison of targeted and systematic prostate biopsies in naïve biopsied men. JAMA Surgery. doi.org/10.1001/jamasurg.2019.1734.
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