Study: Targeted Biopsy Improves Accuracy of Prostate Cancer Diagnoses

Researchers from the National Cancer Institute have found that using a type of targeted biopsy finds more high-risk prostate cancers and fewer low-risk prostate cancers than standard biopsy. The ability to accurately determine whether a man’s prostate cancer will grow slowly or quickly is important information in helping him decide how best to treat it. The study was published January 27, 2015 in Journal of the American Medical Association.

The study involved 1,003 men who had previously had a PSA blood test or digital rectal exam (DRE) that raised concerns. All the men in the study had both targeted and a type of standard biopsies of the prostate gland to look for cancer.

For a targeted biopsy procedure, first the prostate is examined with MRI to look for areas that look abnormal and are more likely to contain cancer. Then an ultrasound is done with special equipment that matches the ultrasound images with the MRI in real time. This allows the doctor to target the abnormal areas for biopsy. In the type of standard biopsy used in the study, ultrasound is used to identify the prostate, but samples of tissue are removed randomly from different areas of the prostate. Usually about 12 samples of tissue are looked at.

The study showed that targeted biopsy found 30% more high-risk cancers than standard biopsy and 17% fewer low-risk cancers. This could have implications for doctors and patients when deciding how to treat prostate cancer. While high-risk cancers are usually treated because they are likely to be life-threatening, many low-risk prostate cancers grow so slowly that they may never cause a man any problems, and therefore might only need close observation unless the tumor grows.

The study did not look at whether targeted biopsy reduced prostate cancer deaths or recurrences and calls for future studies to look at those outcomes.

American Cancer Society Chief Medical Officer Otis Brawley, MD, said that while the targeted biopsy in the study helped to find more aggressive looking cancers, it will take several years to discover whether this will benefit men clinically. However, he said that reducing the number of tissue samples needed could make biopsies safer.

“We have quite a few people who develop infection because of biopsies today, and if we can reduce the number of needle sticks into the prostate, we may decrease the number of people who end up with infections and that is the benefit,” said Brawley.

A personal decision

How actively to treat prostate cancer that was caught early is a very personal decision. Options might include just carefully monitoring the cancer to see if it grows, or treating it with surgery or radiation. Some men may be more concerned about removing or destroying the cancer, while other men may be more concerned about avoiding or delaying possible side effects from treatment such as incontinence and impotence. It’s important for men considering prostate cancer treatment to be fully informed about all their options and to have an open, honest discussion with their doctor.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Comparison of MR/Ultrasound Fusion–Guided Biopsy With Ultrasound-Guided Biopsy for the Diagnosis of Prostate Cancer. Published January 27, 2015 in Journal of the American Medical Association. First author M. Minhaj Siddiqui, MD, National Cancer Institute, Bethesda, Md.

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