Could abbreviated biparametric magnetic resonance imaging (bpMRI) emerge as the new standard of care for prostate cancer (PCa) detection?
For a new multicenter study, recently published in the Journal of the American Medical Association (JAMA), researchers compared abbreviated bpMRI (utilizing T2-weighted and diffusion-weighted imaging (DWI)) and multiparametric MRI (mpMRI) for 490 biopsy-native men (median age of 65 and median PSA level of 5.6) with raised suspicion of PCa. The cohort was derived from 22 centers in 12 countries, according to the study.
The study authors found that abbreviated bpMRI detected clinically significant PCa (csPCa) in 29.2 percent of the cohort in comparison to 29.6 percent for mpMRI.
In a multicenter study of men with clinical suspicion of prostate cancer (PCa), researchers found that abbreviated bpMRI offered comparable detection rates to mpMRI for clinically significant prostate cancer (csPCa).
The researchers also noted comparable numbers between abbreviated bpMRI and mpMRI with respect to sensitivity (98 percent vs. 99.3 percent), specificity (61.6 percent vs. 60.1 percent), positive predictive value (PPV) (53.1 percent vs. 52.5 percent) and negative predictive value (NPV) (98.6 percent vs. 99.5 percent).
The researchers also noted similar detection rates between abbreviated bpMRI and mpMRI for clinically insignificant PCa (9.2 percent vs. 9.6 percent).
“The PRIME study demonstrates that a shorter and less resource-intensive biparametric MRI detects as much clinically significant cancer as the full multiparametric MRI, without increasing the diagnosis of clinically insignificant cancer. Despite earlier concerns that lack of contrast information would lead to more biopsy recommendations, this study found no evidence of this, with biopsy rates being very similar between biparametric MRI and multiparametric MRI,” noted lead study author Alexander Ng, MBBS, who is affiliated with the Division of Surgery and Interventional Science at University College London in the United Kingdom, and colleagues.
Three Key Takeaways
- Comparable diagnostic accuracy. Abbreviated biparametric MRI (bpMRI) demonstrated nearly identical detection rates for clinically significant prostate cancer (csPCa) compared to multiparametric MRI (mpMRI), with similar sensitivity, specificity, PPV, and NPV.
- No increase in overdiagnosis or biopsy rates. bpMRI showed similar detection of clinically insignificant prostate cancer and did not lead to higher biopsy recommendations, addressing prior concerns about omission of contrast.
- Practical advantages. bpMRI offers shorter scan times, avoids gadolinium contrast, improves throughput, and reduces risks and costs, making it a promising alternative to mpMRI for broader clinical use.
Noting the potential ramifications of these findings in light of approximately four million prostate MRI exams being performed annually in the United States, the researchers emphasized the advantages of an abbreviated bpMRI protocol with respect to improved access, efficiency and safety.
“The significant benefits of a biparametric MRI approach include a shorter scan for the patient, improved scanner throughput for the health care system, avoiding the need for gadolinium contrast, elimination of cannulation and contrast-agent safety risks, avoiding the need for a physician to be present during scanning, and reduced environmental toxicity,” added Ng and colleagues.
(Editor’s note: For related content, see “Could a Specificity Emphasis for MRI-Based T-Staging Reinvent Staging for Prostate Cancer?,” “MRI-Based Deep Learning Model Bolsters Prediction of PI-RADS 3 and 4 Lesions” and “Large Medicare Study Shows Black Men Less Likely to Receive PET and MRI for Prostate Cancer Imaging.”)
In regard to study limitations, the authors acknowledged the possibility of bias underestimating cancer detection with mpMRI and noted the study data was derived from centers with highly experienced radiologists and biopsy operators. The researchers also emphasized the importance of ensuring quality MRI scans prior to adopting an abbreviated MRI protocol for prostate cancer screening.