Choosing the Right Diagnostic Pathway in Biopsy-Naive Patients With Suspected Prostate Cancer
Mené sur 453 patients présentant des signes cliniques de cancer de la prostate et n'ayant jamais subi de biopsies prostatiques, cet essai multicentrique de phase III évalue la non infériorité, du point de vue du taux de détection de cancers de la prostate dont le groupe de grade est égal ou supérieur à 2, d'une biopsie ciblée par IRM multiparamétrique par rapport à une série de 12 biopsies transrectales guidées par échographie
In the prospective multicenter Prostate Evaluation for Clinically Important Disease: Sampling Using Image-Guidance or Not? (PRECISION) trial, 500 biopsy-naive patients with suspected prostate cancer were randomly assigned to either classical 10- to 12-core systematic biopsy or to magnetic resonance imaging (MRI) and targeted biopsy without systematic biopsy if MRI was suggestive of cancer. The detection rate for cancers with an International Society of Urological Pathology (ISUP) grade 2 or higher was significantly higher in men assigned to MRI and targeted biopsy (38%) than in those assigned to systematic biopsy (26%; P = .005). In addition, overdiagnosis of ISUP grade 1 cancer was reduced in the MRI-targeted biopsy group (9% vs 22%, P < .001), and 28% of men in this group avoided biopsy.
JAMA Oncology , éditorial, 2020