Significant prostate cancer after negative MRI and systematicbiopsy
MRI scan of the prostate has become standard of care in patients with a raised PSA test in
the absence of a urine infection before a prostate biopsy is performed. It is around 85%
accurate. So, the question is what to do if the PSA is persistently raised or there is clinical
suspicion of prostate cancer due to an abnormal feeling gland, despite a previous biopsy
showing no cancer or a benign looking MRI scan?
This was studied in a subgroup of >400 men from the FUTURE trial who had thorough
systematic biopsies of the prostate through the rectum. This is otherwise known as TRUS
In those men with non-suspicious MRI a clinically significant prostate cancer was diagnosed
in 3%. This means that the risk of prostate cancer in this group of patients is low. However,
compared to the general population the risk of diagnosing significant prostate cancer
remains higher and follow-up in recommended.
In our practice, prostate biopsies are performed through the perineum, thus avoiding the
rectum. We target the suspicious areas on MRI and add systematic biopsies to other parts of
the prostate so as not to miss MRI invisible cancers. So, our pickup rate is higher than in
TRUS biopsies. We also have a lower risk of sepsis by avoiding the rectum.
I also think that PSMA PET scanning will play a greater role in picking up significant cancers
by increasing the sensitivity of MRI.
The original article is here-