PRIME backs biparametric MRI diagnosis
Abbreviated biparametric magnetic resonance imaging (MRI), with or without targeted biopsy, is noninferior to multiparametric MRI for prostate cancer diagnosis in the PRIME trial, and “could become a new standard of care.”
Published in JAMA, PRIME enrolled biopsy-naive men with suspected prostate cancer across 22 centers internationally. Biparametric MRI detected clinically significant disease in 143/490 (29.2%) of men, compared with 145/490 (29.6%) using multiparametric MRI, meeting the trial’s noninferiority objective.
Importantly, biparametric MRI did not appear to increase downstream biopsy recommendations: scans triggering biopsy were similar with biparametric versus multiparametric MRI (273/490 versus 280/490). Clinically insignificant cancer detection was also comparable (45/490 versus 47/490).
The findings could have “critical global health implications,” note Alexander Ng (University College London, UK) and co-authors, as omitting dynamic contrast-enhanced (DCE) imaging can shorten scan time and reduce reliance on contrast administration and associated staffing requirements.
DCE sequences did reveal newly suspicious areas in a small minority of patients (31/490; 6.3%). Biparametric MRI did not differ considerably overall, but DCE-targeted biopsy rarely added clinically significant cancer detection (29/31; 93.5% showed no additional detection). In multidisciplinary review, DCE changed treatment eligibility decisions in 21/488 (4.3%) cases and treatment planning decisions in 15/488 (3.1%) cases.
Limitations include the high scan quality achieved in the trial (which may not be replicated everywhere), potential reader bias related to the order of scan interpretation, and results representative of practice in centers with experienced radiologists and biopsy operators.
All patients underwent multiparametric MRI acquisition; radiologists reported an abbreviated biparametric MRI first, blinded to the DCE sequence. Men with areas scoring 3–5 on the Likert scale, indicating a likelihood of clinically significant prostate cancer, received a targeted prostate biopsy. Eligibility criteria included elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination findings, PSA ≤20 ng/mL, and no prior MRI or biopsy.
The authors conclude that the PRIME trial provides level 1 evidence that “biparametric MRI could be an alternative first-line diagnostic test to multiparametric MRI for cancer diagnosis in men with suspected prostate cancer.”
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