Could a “man-ogram” replace needless prostate biopsies?

I don’t get many chances to address men’s health directly. And since we’re on the subject of screening breakthroughs this week, I couldn’t think of a better time to share some more exciting news: There may soon be a “man-ogram” available to guys, too.

It’s called a fast biparametric (bp) MRI. And it’s an imaging test that could replace biopsies—which as you may already know, can be painful and carry complications—in the hunt for prostate cancer.

A new standard in the fight against prostate cancer?

There are quite a few tests available right now that men and their doctors can use to help guide decision-making where biopsy is concerned. And the controversial prostate-specific antigen (PSA) is only one of them.

You also have the PCA3 test and the 4K test—and of course, MRIs, which are only getting better at detecting prostate cancer. Still, biopsies remain far too common.

That’s where this new test comes in. Its advocates are proposing it as the first step of any prostate cancer workup. And the authors of a new study believe it means that prostate MRIs for men could soon become as common as mammograms for women.

For one thing, it avoids the common pitfalls of tests like the PSA. And while I personally believe proper PSA testing is still a valuable piece of the puzzle, mishandling of results by overzealous doctors has led to overdiagnosis of generally benign cancers, and unnecessary mutilation.

That’s because, as a marker, PSA is notoriously unpredictable. Yes, it could point to cancer. But it’s also influenced by sex, exercise, diet, and infections.

Ultimately, MRIs offer something a little more concrete. And with fast biparametric MRI, you don’t have to fuss with contrast, and it takes less than 13 minutes. (As opposed to multiparametric MRI, which—while a step in the right direction—uses potentially harmful contrast and takes upwards of 20 minutes.)

Still, researchers admit that while this non-contrast test is faster and potentially cheaper, there are still questions about its ability to rule out serious disease. But since neither method is perfect, let’s take a closer look at their results…

Knowledge is power

This new study placed contrast-enhanced multiparametric MRI against fast biparametric MRI in a head-to-head comparison of performance as a diagnostic tool for clinically significant prostate cancer.

The study included more than 600 men who had never received a biopsy. And of course, they all underwent pre-biopsy MRI.

Prostate cancer sensitivity was just shy of 95 percent, regardless of the protocol. Specificity of the new fast bp-MRI was just over 65 percent—compared with just over 68 percent using the more involved scans. But it also flagged one percent more insignificant cancers.

Cost-wise, fast bp-MRI would cut direct expenses by more than half. But results suggest that total costs are pretty much the same with either test—as fast bp-MRI increases biopsy and overdiagnosis rates by two percent and one percent, respectively.

All of which is to say that fast bp-MRI’s future as the gold standard “man-ogram” is uncertain, at best.

Still, there’s little question that MRI itself is a useful tool—as it helps avoid overdiagnosis (and overtreatment) of low-risk tumors and unnecessary biopsies, and/or ultimately guides men and their doctors in a way that minimizes risk and maximizes benefit.

Yet insurers aren’t buying in. Probably because, at the end of the day, it’s expensive. And if most prostate cancers don’t require treatment anyway, they’re not prepared to foot the bill.

So, there’s no saying how widely available this screening test will ever be. Nevertheless, it’s food for thought for any man out there facing a potential biopsy. Because if you decide to opt in, I believe it’s always better to do it armed with as much information as possible.

Knowledge is power. And in this case, it could be life-saving, in more ways than one.

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Source:

“Could a ‘Manogram’ Replace a Prostate Biopsy?” Medscape Medical News, 08/01/2019. (medscape.com/viewarticle/916297)