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Combining Prostate MRI with Blood Test Can Avoid Unnecessary Prostate Biopsies

By MedImaging International staff writers
Posted on 01 Apr 2024

Image: Unnecessary prostate biopsies can be avoided by combining MRI of the prostate findings with PSA density (Photo courtesy of 123RF)

Prostate cancer ranks as the second most prevalent cancer among men globally. For a long time, researchers have acknowledged that not every instance of prostate cancer poses a danger that warrants immediate treatment or even a biopsy. Clinically significant prostate cancer (csPCa) is identified as cancer with a higher likelihood of becoming life-threatening, characterized by cells that appear more aggressive or cancer found outside of the prostate gland. Differentiating which cancers necessitate treatment without conducting a biopsy presents a challenge. Traditional biopsies are required to assess the aggressiveness of cancer cells, yet these procedures can be uncomfortable, invasive, and costly. Now, new research suggests that combining an MRI of the prostate with a blood test could effectively identify clinically significant prostate cancers.

Investigators from Brigham and Women’s Hospital (Boston, MA, USA) have suggested that unnecessary prostate biopsies can be avoided by combining MRI findings with prostate-specific antigen (PSA) density measurements. This novel diagnostic strategy aims to minimize the harm and healthcare costs associated with prostate biopsies. The study explored a new methodology that correlates MRI-based prostate imaging reporting and data system (PI-RADS) scores with PSA density (PSAD) to identify cancers likely to be clinically significant without biopsy data. PI-RADS assesses prostate lesions on a scale from 1 (unlikely to be clinically significant) to 5 (high likelihood of being clinically significant). PSAD is calculated by dividing the PSA level by the volume of the prostate, as determined via MRI.

Building on earlier research conducted exclusively at Brigham Women's Hospital, which suggested that PI-RADS and PSAD thresholds could eliminate the need for biopsies in up to half of the cases, the recent study analyzed data from 72 published studies encompassing over 36,000 men with prostate cancer. This analysis aimed to validate whether the initial findings could be generalized across a broader population. Results indicated that prostate biopsies might be redundant for patients with PI-RADS scores below 4 and PSAD less than 0.10 ng/ml2. Utilizing specific PI-RADS and PSAD thresholds, it was determined that 50% of biopsies could be omitted, risking the miss of only 5% of clinically significant cancers, or alternatively, skip 30% of biopsies and miss just 3% of such cancers. The research team plans to develop an easy-to-use patient-level scoring system that would enable urologists to more accurately evaluate the need for a biopsy.

"In the workup of men suspected of having prostate cancer, prostate MRI findings combined with PSA density measurement can help doctors decide which patients to biopsy," said senior author Ramin Khorasani, MD, MPH, Radiology Vice Chair for Quality and Safety at Brigham and Women’s Hospital and Mass General Brigham and Philip H. Cook Professor of Radiology at Harvard Medical School. "With this new analysis, we looked to see how MRI can help urologists decide which patients to biopsy and which patients may not need aggressive diagnosis and treatment."

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89 (154.97207641602): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (!!!!! 4765.0337219238): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

91 (206.23207092285): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

92 (!!!!! 1053.0948638916): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800721 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

93 (478.98292541504): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

94 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

95 (!!!!! 3222.9423522949): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294800721 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

96 (579.1187286377): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

97 (332.11708068848): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

98 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

99 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

100 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

101 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

102 (281.09550476074): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

103 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

104 (263.92936706543): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

105 (!!!!! 85905.075073242): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

106 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

107 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

108 (441.07437133789): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800721 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800721 AND type='deeppockets_item' AND published='1' LIMIT 1

109 (!!!!! 1287528.9916992): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

110 (!!!!! 1887591.8388367): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

111 (!!!!! 4276.0372161865): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

112 (!!!!! 1043.0812835693): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

113 (407.93418884277): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

114 (148.77319335938): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

115 (!!!!! 1456.9759368896): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

116 (694.99015808105): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

117 (!!!!! 3802.0610809326): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

118 (!!!!! 2367.9733276367): SELECT name FROM jos_deeppockets WHERE id=212

119 (56.028366088867): SELECT name FROM jos_deeppockets WHERE id=212

120 (!!!!! 2016.7827606201): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

121 (!!!!! 1027.1072387695): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

122 (!!!!! 10174.989700317): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

123 (495.19538879395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

124 (!!!!! 20277.02331543): TRUNCATE TABLE jos_trademed_module

125 (!!!!! 1667.9763793945): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800721 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

126 (!!!!! 1219.0341949463): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

127 (!!!!! 2543.9262390137): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

128 (!!!!! 1039.981842041): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

129 (!!!!! 1965.9996032715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

130 (!!!!! 2234.935760498): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

131 (929.83245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

132 (383.13865661621): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

133 (391.00646972656): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800721 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800721 AND type='deeppockets_item' AND published='1' LIMIT 1

134 (!!!!! 1836.0614776611): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

135 (905.99060058594): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

136 (!!!!! 1047.8496551514): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

137 (!!!!! 5156.9938659668): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

138 (!!!!! 1863.956451416): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1' LIMIT 1

139 (145.91217041016): select jos_twitters.link from jos_twitters where cat=10

140 (272.98927307129): select jos_facebook.link from jos_facebook where cat=10

141 (36.954879760742): select jos_google_plus.link from jos_google_plus where cat=10

142 (243.9022064209): select jos_linkedin.link from jos_linkedin where cat=10

143 (350.9521484375): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

144 (!!!!! 8867.9790496826): insert into jos_banners_delta values (14615,'2025-04-29 10:23:38','3.148.162.188','view'),(14202,'2025-04-29 10:23:38','3.148.162.188','view'),(14203,'2025-04-29 10:23:38','3.148.162.188','view')

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