The debate around prostate-specific antigen (PSA) testing for cancer could potentially be resolved by using magnetic resonance imaging, say Australian researchers.
PSA testing is often discouraged due to over diagnosis and subsequent unnecessary treatment of benign tumours.
An mpMRI (multiparametric magnetic resonance imaging) would be more reliable in detecting significant prostate cancers while excluding tumours which don’t need treatment.
Writing in the Medical Journal of Australia, Dr Jeremy Grummet and Associate Professor Richard O’Sullivan, from Epworth Healthcare in Melbourne, say decisions about PSA testing of men aged 55–69 years should be shared by doctors and individual patients rather than by population-based screening.
An elevated PSA level typically leads to a ultrasound-guided biopsy. About half of all these biopsies are negative for cancer.
“A large proportion of the prostate cancer currently diagnosed by the combination of an elevated PSA level and a TRUS biopsy is actually low-risk disease,” the doctors write. “The vast majority of such cases require nothing more than active surveillance, but many of the men involved, unfortunately, are subjected to unnecessary treatments, although this is improving.”
Grummet and O’Sullivan suggested that imaging may be a diagnostic tool that can more reliably detect significant prostate cancer.
Two studies, one in Sydney and one in Brisbane, have found that “mpMRI was considerably more sensitive than TRUS biopsy in detecting significant cancer”. Only 3% were missed by imaging in the Brisbane study, compared with 28% not detected by biopsy.
Even though mpMRI is not currently reimbursed by Medicare, “it may ultimately be cost-effective”, the doctors say.
“The role of mpMRI in prostate cancer detection is rapidly evolving,” Grummet and O’Sullivan wrote.
“It has the potential to revolutionise both the diagnosis and treatment of prostate cancer.”
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