A biopsy is an unpleasant, often painful test. And while it was said to be the best way to diagnose cancer, it turned out that MRI was better for it. The prestigious “Lancet” has just published the results of a study conducted at the University College London Hospitals among men with suspected prostate cancer. Unfortunately, the MRI in Poland is not the first-choice test and costs as much as PLN 1000. Maybe it’s time to change it? Even from a purely human but economic perspective, financing it for all men would burden the state budget less than treating cancer in those who, fearing biopsy for years, avoided it.
Not only can prostate biopsy be painful and unpleasant, but it also carries the risk of serious complications, including sepsis (infection-induced systemic inflammatory reaction syndrome (SIRS)).
Recent studies suggest a complete change in the diagnostic procedure when prostate cancer is suspected. Now, the first examination to be performed when prostate cancer is suspected will be magnetic resonance imaging. A prostate biopsy will be necessary only when the result is in doubt. The same is true for women suspected of having breast cancer. First, mammography and ultrasound are ordered, and only then a section is taken for histopathological examination.
The effectiveness of such action is confirmed by studies by specialists from University College London Hospitals, who used the so-called Multiparameter Magnetic Resonance Imaging (mpMRI). It does not require the use of contrast and allows the detection of medium and high stage cancer with a volume of about 0,5 cubic cm (depending on the location and nature of the tissue within and around the identified lesions).
Studies with this device were carried out on 576 men at 11 centers in the United Kingdom. They found that the use of mpMRI in men with high blood PSA is sufficient to rule out nearly 90 percent of the patients. the presence of clinically significant prostate cancer without the need for a tissue biopsy.
One of the authors of the study, Dr. Hashim Ahmed from University College London Hospitals in an interview with “BBC News” admitted that multiparameter magnetic resonance imaging allows you to avoid biopsy in 27% of patients. men suspected of having prostate cancer because no change is detected. To be sure that MRI can really replace a biopsy, more studies are needed on a larger group of patients.
If they are successful, then perhaps a revolution awaits us. Classic biopsy is ineffective. To perform it, you need a special ultrasound machine (TRUS), which is not very accurate. MpMRI is almost twice as accurate as TRUS: this MRI can recognize 93% of patients. clinically significant prostate tumors, while ultrasound – only 48 percent.
Observations by University College London Hospitals specialists have shown that if a prostate biopsy is necessary, then thanks to mpMRI examination in three-quarters of cases, diagnosis may end with one biopsy. In the case of traditional ultrasound examination, it often needs to be repeated. Thanks to mpMRI, it is possible to locate the lesion more precisely and determine its nature.
A similar situation applies to the diagnosis of breast cancer. Many countries reimburse women for MRI because it is much more effective than mammography in detecting and assessing breast changes. In Poland, women still have to pay for this test. Only those who have already detected a lesion suspected of being a malignant neoplasm have them for free.