MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis
| Autor: | Kasivisvanathan, Veeru, Rannikko, Antti S, Borghi, Marcelo, Panebianco, Valeria, Mynderse, Lance A, Vaarala, Markku H, Briganti, Alberto, Budäus, Lars, Hellawell, Giles, Hindley, Richard G, Roobol, Monique J, Eggener, Scott, Ghei, Maneesh, Villers, Arnauld, Bladou, Franck, Villeirs, Geert M, Virdi, Jaspal, Boxler, Silvan, Robert, Grégoire, Singh, Paras B, Venderink, Wulphert, Hadaschik, Boris A, Ruffion, Alain, Jim C, Hu, Margolis, Daniel, Crouzet, Sébastien, Klotz, Laurence, Taneja, Samir S, Pinto, Peter, Gill, Inderbir, Allen, Clare, Giganti, Francesco, Freeman, Alex, Morris, Stephen, Punwani, Shonit, Williams, Norman R, Brew-Graves, Chris, Deeks, Jonathan, Takwoingi, Yemisi, Emberton, Mark, Moore, Caroline M, Precision, Study Group Collaborators, Catalano, Carlo, Leonardo, Costantino, Sciarra, Alessandro, Grompone, Marcello Domenico, Del Monte, Maurizio, D'Eramo, Giuseppe, Salvo, Vincenzo, Campa, Riccardo |
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| Přispěvatelé: | Urology, Kasivisvanathan, V., Rannikko, A. S., Borghi, M., Panebianco, V., Mynderse, L. A., Vaarala, M. H., Briganti, A., Budäus, L., Hellawell, G., Hindley, R. G., Roobol, M. J., Eggener, S., Ghei, M., Villers, A., Bladou, F., Villeirs, G. M., Virdi, J., Boxler, S., Robert, G., Singh, P. B., Venderink, W., Hadaschik, B. A., Ruffion, A., Hu, J. C., Margolis, D., Crouzet, S., Klotz, L., Taneja, S. S., Pinto, P., Gill, I., Allen, C., Giganti, F., Freeman, A., Morris, S., Punwani, S., Williams, N. R., Brew-Graves, C., Deeks, J., Takwoingi, Y., Emberton, M., Moore, C. M., for the PRECISION Study Group, Collaborators |
| Rok vydání: | 2018 |
| Předmět: |
Male
fusion Intention to Treat Analysi Cost effectiveness Biopsy 030232 urology & nephrology Medizin outcomes Prostate cancer 0302 clinical medicine Surveys and Questionnaire 610 Medicine & health medicine.diagnostic_test Medicine (all) Prostate magnetic-resonance General Medicine Middle Aged Magnetic Resonance Imaging PI-RADS 030220 oncology & carcinogenesis Urological cancers Radboud Institute for Health Sciences [Radboudumc 15] Radiology Human Quality Control medicine.medical_specialty men Risk Assessment ultrasound-guided biopsy active surveillance cost-effectiveness Follow-Up Studie 03 medical and health sciences All institutes and research themes of the Radboud University Medical Center SDG 3 - Good Health and Well-being Urological cancers Radboud Institute for Molecular Life Sciences [Radboudumc 15] medicine Ultrasonography Interventional Aged Intention-to-treat analysis business.industry Cancer Magnetic resonance imaging medicine.disease Prostatic Neoplasm Quality of Life Ultrasound-Guided Biopsy business |
| Zdroj: | The New England Journal of Medicine, 378, 1767-1777 New England Journal of Medicine, 378(19), 1767-1777. Massachussetts Medical Society The New England Journal of Medicine, 378, 19, pp. 1767-1777 |
| ISSN: | 1533-4406 0028-4793 |
| Popis: | BACKGROUND: Multiparametric magnetic resonance imaging (MRI), with or without targeted biopsy, is an alternative to standard transrectal ultrasonography-guided biopsy for prostate-cancer detection in men with a raised prostate-specific antigen level who have not undergone biopsy. However, comparative evidence is limited. METHODS: In a multicenter, randomized, noninferiority trial, we assigned men with a clinical suspicion of prostate cancer who had not undergone biopsy previously to undergo MRI, with or without targeted biopsy, or standard transrectal ultrasonography-guided biopsy. Men in the MRI-targeted biopsy group underwent a targeted biopsy (without standard biopsy cores) if the MRI was suggestive of prostate cancer; men whose MRI results were not suggestive of prostate cancer were not offered biopsy. Standard biopsy was a 10-to-12-core, transrectal ultrasonography-guided biopsy. The primary outcome was the proportion of men who received a diagnosis of clinically significant cancer. Secondary outcomes included the proportion of men who received a diagnosis of clinically insignificant cancer. RESULTS: A total of 500 men underwent randomization. In the MRI-targeted biopsy group, 71 of 252 men (28%) had MRI results that were not suggestive of prostate cancer, so they did not undergo biopsy. Clinically significant cancer was detected in 95 men (38%) in the MRI-targeted biopsy group, as compared with 64 of 248 (26%) in the standard-biopsy group (adjusted difference, 12 percentage points; 95% confidence interval [CI], 4 to 20; P = 0.005). MRI, with or without targeted biopsy, was noninferior to standard biopsy, and the 95% confidence interval indicated the superiority of this strategy over standard biopsy. Fewer men in the MRI-targeted biopsy group than in the standard-biopsy group received a diagnosis of clinically insignificant cancer (adjusted difference, -13 percentage points; 95% CI, -19 to -7; P |
| Databáze: | OpenAIRE |
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