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The British study that measured how bad the standard prostate biopsy really was, and how good a scan could be instead: the evidence that put MRI before the needle in the NHS.
PROMIS gave 576 men all three tests and compared each against a 5 mm template mapping biopsy taken through the perineum, which is as close to ground truth as a living prostate allows. Defining clinically significant cancer as Gleason 4+3 or worse, or a maximum cancer core length of 6 mm or more, 408 of 576 men (71 percent) had cancer and 230 (40 percent) had clinically significant cancer.
Multiparametric MRI had a sensitivity of 93 percent (95 percent confidence interval 88 to 96) against 48 percent (42 to 55) for transrectal biopsy; the trade was specificity, 41 percent (36 to 46) against 96 percent (94 to 98). Used as a triage test, MRI would let 27 percent of men avoid a primary biopsy altogether, diagnose 5 percent fewer clinically insignificant cancers, and detect up to 18 percent more clinically significant cancers if the biopsies that followed were MRI-directed. Forty-four of 740 men (5.9 percent) had a serious adverse event, including eight cases of sepsis: the harm the scan is there to avoid. NICE NG131 recommendation 1.2.2 now makes multiparametric MRI the first-line investigation for suspected clinically localised prostate cancer, reported on a five-point Likert scale, and box 1 of the guideline quotes PROMIS by name for the numbers a man needs when deciding whether to have a biopsy after a Likert 1 or 2 scan.
Shares Hashim U. Ahmed, Imperial College Healthcare NHS Trust / Imperial College London Cancer Research, University College London Hospitals / UCL Cancer Institute, PSA (prostate-specific antigen) and the tags uk, prostate.
Shares Hashim U. Ahmed, Mark Emberton, Imperial College Healthcare NHS Trust / Imperial College London Cancer Research, Prostate cancer and the tags uk, prostate.
Shares PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk, Prostate cancer and the tags uk, prostate.
Shares Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk, Prostate cancer and the tags uk, prostate.
Shares Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk, Prostate cancer and the tags uk, prostate.
Shares Hashim U. Ahmed, Mark Emberton, Localised prostate cancer, very low and low risk, Prostate cancer.
Shares Prostate cancer and the tags uk, prostate.
Shares Mark Emberton, University College London Hospitals / UCL Cancer Institute, PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk.