CIANJ Commerce Magazine September 2020 Live | Page 64

TREATING PROSTATE/OVARIAN CANCER
Combining Tests More Accurately
Diagnoses Prostate Cancer
Compiled by the
National Cancer Institute,
National Institutes of Health
Prostate cancer is the most common cancer
among men in the United States and the
second leading cause of male cancer deaths.
But prostate cancer can vary widely in severity
and its potential to spread.
Low-grade prostate cancer is associated with
a very low risk of cancer-specific death and
often doesn’t require treatment. High-grade
cancers are much more likely to spread and are
responsible for most prostate cancer deaths.
This makes the correct assessment of the cancer
grade very important for treatment decisions.
Finding and treating cancers before symptoms
occur may improve men’s health or help them
live longer.
Systematic biopsy is often used to diagnose
prostate cancer. This is a non-targeted method
of taking systematically spaced samples across
the prostate gland to find a cancer. Because this
method can potentially miss areas of cancer, doctors
may then overtreat a patient with low-grade
disease, fearing there is high-grade disease they
missed. Or, if an aggressive cancer is missed, a patient
may be undertreated.
MRI-targeted biopsies, which combine MRI
images of suspected cancer with real-time ultrasound
technology to target areas for biopsy, are
better able to detect more high-grade cancers
than systematic biopsies. A team led by Dr. Peter
A. Pinto at the National Institutes of Health’s
(NIH’s) National Cancer Institute (NCI) carried
out a study to determine whether it would be
better to replace systematic biopsy with MRI-targeted
biopsies or use both tests together. They
compared these methods on more than 2,100
men who had MRI-visible lesions. The study was
funded in part by NCI and NIH’s Clinical Center.
Results were published on March 5, 2020, in the
New England Journal of Medicine.
Participants underwent both MRI-targeted
and systematic biopsies. More than 1,300 were
diagnosed with cancer and 404 underwent prostatectomy,
a full removal of the prostate. By comparing
diagnoses from systematic biopsy alone to
systematic biopsy plus MRI-targeted biopsy, the
researchers found that combining the methods
led to 208 more cancer diagnoses than systematic
biopsy alone. The addition of MRI-targeted
biopsy also led to 458 upgrades—changes in diagnosis
to a more-aggressive cancer, based on analysis
of the biopsy tissue.
The combined biopsy provided more accurate
diagnoses. Among the men who underwent
prostatectomy, systematic biopsy alone underdiagnosed
about 40 percent of the cancers.
MRI-targeted biopsy alone underdiagnosed
about 30 percent. The combined biopsy underdiagnosed
only 14.4 percent. For the most aggressive
cancers, systematic biopsy underdiagnosed
16.8 percent and MRI-targeted biopsy 8.7 percent,
but combined biopsy underdiagnosed only
3.5 percent.
“Prostate cancer has been one of the only solid
tumors diagnosed by performing systematic
biopsies ‘blind’ to the cancer’s location,” said
Pinto. “For decades this has led to the overdiagnosis
and subsequent unnecessary treatment of
non-lethal cancers, as well as to missing aggressive
high-grade cancers and their opportunity for
cure. With the addition of MRI-targeted biopsy
to systematic biopsy, we can now identify the
most lethal cancers within the prostate earlier,
providing patients the potential for better treatment
before the cancers spread.”
Adding MRI-targeted biopsies to the traditional prostate biopsy created a more accurate diagnosis and prediction of the course of prostate cancer.
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