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Prostate MRI is good at answering whether a man has a serious cancer somewhere. This study matched scans against the whole removed prostate and found it is much worse at finding every tumour: it missed at least one significant tumour in a third of men.
Dave Johnson, Steven Raman and colleagues at the University of California, Los Angeles co-registered multiparametric magnetic resonance imaging with whole-mount pathology from 588 consecutive men who had radical prostatectomy after a 3 Tesla scan, giving 1,213 pathologically confirmed tumour foci, and measured per-lesion rather than per-patient sensitivity.
The distinction is not academic. A pathway that only has to decide whether to biopsy needs per-patient sensitivity, and PROMIS showed that is 93 percent for clinically significant disease. A pathway that decides where to treat, which is what focal therapy and magnetic resonance imaging-only surveillance do, needs per-lesion sensitivity, and this study puts that at 45 percent for all foci and 65 percent for clinically significant ones. The gap between the two numbers is where focal therapy planning and imaging-only follow-up carry unmeasured risk.
The limit of what a prostate scan can be asked to do. It is a good triage test for whether to biopsy and a poor map of where every tumour is, which matters for anyone being offered treatment to part of the gland or follow-up by imaging alone.
Pre-biopsy MRI with targeted sampling is now the standard diagnostic pathway for suspected prostate cancer, reducing overdiagnosis of low-risk disease.
The evidence that put a scan in front of the biopsy. It reduces the number of men who are biopsied at all, reduces the number of harmless cancers found, and increases the number of dangerous ones, which is the only combination that improves a screening pathway on both sides at once.
Shares Radical prostatectomy, PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk and the tag prostate-evidence.
Shares Radical prostatectomy, Gleason score / Grade Group, Localised prostate cancer, intermediate risk, Localised prostate cancer, high and very high risk and the tag prostate-evidence.
Shares European Urology, Gleason score / Grade Group, PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk and the tag prostate-evidence.
Shares Radical prostatectomy, PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk and the tag prostate-evidence.
Shares PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch and the tag prostate-evidence.
Shares PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk, Localised prostate cancer, high and very high risk and the tag prostate-evidence.
Shares PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch and the tag prostate-evidence.
Shares PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk, Localised prostate cancer, high and very high risk and the tag prostate-evidence.