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According to Swedish research, using MRI to better target biopsies in prostate cancer screening would reduce the risk of overdiagnosis by two. A significant fact when, by prevention, many men still undergo unnecessary interventions.
The first cancer in men in France to date, prostate cancer is monitored as closely as possible to patients. However, a problem arises: a very high proportion of the cases of cancers detected represent small tumours, which are often harmless. But difficult to distinguish those which will not evolve and those which will involve the vital prognosis… Which entails a risk of “over-treatment” with the possible related complications (urinary incontinence, impotence…). But according to the University of Gothenburg, this risk of overdiagnosis could be halved by using prostate MRI and performing targeted biopsies only in suspicious areas. Their study is published in the New England Journal of Medicine.
Focus on targeted tissue samples
Almost 38,000 Swedes between the ages of 50 and 60 have been asked to take the prostate-specific antigen (PSA) blood test. Those with elevated PSA levels were offered magnetic resonance imaging (MRI) of the prostate. The 17,980 men who participated (47%) were divided into two groups.
- In the reference group, all those with elevated PSA levels were offered routine tissue sampling, with 12 “blind” tissue samples taken from different parts of the prostate, as is usually done. If the MRI showed anything suspicious, three or four more targeted tissue samples were taken from the affected area.
- In the experimental group, only men with suspicious results revealed by MRI were selected for tissue sampling. As such, only four targeted tissue samples were taken from the suspect area.
In this way, the researchers found that the risk of finding harmless cancer was halved in the experimental group. On the other hand, serious cancers were not missed: these were found on an almost equal scale in the two groups.
A medically justified screening?
Jonas Hugosson, author of the study, assures him: “This strategy significantly reduces the number of people who need to undergo tissue removal, which is an unpleasant procedure with an associated risk of infection. Additionally, the strategy halves the risk of detecting a harmless tumor, which has been the biggest obstacle to the introduction of widespread screening for prostate cancer”, he continues.
Encouraging results with a caveat, however: in the experimental group, there is a slight risk that the probability of detecting a moderately serious cancer may be slightly delayed in a small proportion of individuals. So, good or bad method?
For Dr. Michael Peyromaure, head of the urology department at Cochin Hospital, this study is interesting:
“As expected, it appears that targeted biopsies after MRI significantly reduce (about half) the detection of so-called “insignificant” cancers, which can be covered by simple monitoring. Hence the authors’ conclusion, which is logical: systematically an MRI then only targeted biopsies makes it possible to limit the “overdiagnosis” of prostate cancer”.
However, this new approach does not currently resolve all the screening questions.
“The disadvantage is that in the event of detection of a so-called “significant” cancer in the target, that is to say potentially aggressive and which requires curative treatment, the urologist will not have a complete tumor map. , yet useful to determine the best treatment: brachytherapy, radiotherapy, total prostatectomy or focal treatment. For some, the lack of information about the presence of tumor foci in all areas of the prostate makes the therapeutic strategy more difficult.” he concludes.