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Title: The role of MRI-targeted biopsy in the diagnosis of prostate cancer
Author: Kasivisvanathan, Veerappan
ISNI:       0000 0004 8499 8946
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2019
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Introduction: The existing standard of care for the diagnosis of prostate cancer, transrectal ultrasound guided prostate (TRUS) biopsy, can miss clinically important prostate cancer and over detect clinically unimportant cancer. Methods: I evaluated MRI followed by a targeted biopsy to MRI-suspicious areas (MRI-TB) as an alternative diagnostic test to TRUS biopsy in men with clinical suspicion of prostate cancer based on raised prostate specific antigen or abnormal digital rectal examination. I first evaluated MRI-TB in a single institution study compared to a detailed test of transperineal prostate biopsy to establish the technique's promise. An international consortium with expertise in MRI-TB was established, amongst which we created reporting guidelines for studies of MRI-TB. In this consortium, we designed and carried out an international multicentre randomized-controlled trial comparing MRI-TB to TRUS biopsy in the detection of cancer. Results: In a single institutional study, I showed that MRI-TB detected a similar amount of clinically significant cancer to a transperineal prostate biopsy whilst requiring fewer biopsies. Within the START (STAndards for Reporting studies of MRI-Targeted biopsy) consortium, we developed international MRI-TB reporting guidelines and PRECISION (PRostate Evaluation for Clinically Important disease: Sampling using Image-guidance Or Not?), a 500 patient, 23-centre, randomized-controlled trial, comparing MRI-TB and TRUS biopsy. PRECISION showed that MRI-TB detected 38% of men with clinically significant prostate cancer (≥Gleason 3+4) compared to 26% for TRUS biopsy (p=0.005), detected fewer men with clinically unimportant prostate cancer (Gleason 3+3) (9 vs 22%, respectively, p < 0.001) and required fewer biopsies (median of 4 vs 12, respectively). Further, 28% of men in the MRI arm could avoid a biopsy and its discomfort and risks altogether. Conclusions: MRI±TB is an attractive test to rival TRUS biopsy as the standard of care for the diagnosis of prostate cancer. It can more efficiently identify men who would benefit from treatment and avoids the diagnosis of men who are less likely to benefit.
Supervisor: Moore, C. ; Emberton, M. ; Van Der Meulen, J. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available