Swedish study shows MRIs can help prevent unneccessary biopsy risks

More webinars coming on focal therapy, lifestyle research

By Howard Wolinsky

Do you have a rising PSA (prostate-specific) antigen level), and your urologist wants to go straight to a biopsy without multiparametric Magnetic Resonance Imaging (MRI)?

Share this article with your doctor and you may be able to get off the merry-go-round and avoid an unnecessary biopsy and accompanying risks, such as sepsis and other infections associated with a transrectal biopsy.

A new Swedish study, published in the JAMA Network, shows mpMRI may be the ideal tool for screening patients with rising PSAs to filter out those with low-risk Gleason 6 cancers to spare them from unnecessary biopsies.

From speaking with patients, I know that screening with MRIs before biopsies is increasingly common, as some guidelines recommend. But some guys are being left out of this best practice.

The study of nearly 24,000 men (average age 61) asks: Is the use of MRI associated with fewer biopsies among patients with suspected prostate cancer?

Dr. David Robinson and colleagues found that pre-biopsy MRI scans result in fewer men undergoing biopsies and also the detection of fewer Gleason score 6 cancers, and detection of more Gleason score 7 or higher cancers.

Fewer Gleason 6 diagnoses also spare men from the hassles and anxiety of Active Surveillance.

Robinson et al. report on a retrospective, population-based cohort of men in Jönköping Region, Sweden. Men with prostate-specific antigen (PSA) blood levels measured between November 2011 and 2020 were monitored until January 31, 2021. Men with known prostate cancer were excluded.

Researchers noted that there was a decrease in the proportion of men with negative biopsies from 28% to 7%, and a concomitant decrease in Gleason 6 cancers from 24% to 6%, whereas the proportion of Gleason score 7 to 10 cancers increased from 49% to 86%.

Robinson et al note: “MRI of the prostate has changed the diagnostic workup of men with increased levels of prostate-specific antigen (PSA). National and international guidelines currently recommend that MRI be performed before a decision is made whether to perform a prostate biopsy. An increasingly common pathway is that when the MRI findings are abnormal, MRI-targeted biopsies are obtained, whereas men with normal findings on MRI do not undergo biopsies.”

Bottomline: Fewer biopsies were performed and the odds of detecting Gleason score 6 cancer decreased, whereas the odds of detecting Gleason score 7 or higher cancer increased. The result is a better outcome for these patients on both ends of the spectrum.

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This study may highlight how the future of prostate diagnostic work-ups.

Things are improving. In 2011, I was among the first U.S. patients who underwent MRI prostate imaging as part of an Active Surveillance—close monitoring—program at the University of Chicago. But the approach was ass-backward—we had biopsies first followed by MRIs. They didn’t know better then. (Read about my disastrous first MRI.)

Another report from the UK last week suggests that MRIs combined with PSAs could reduce the biopsy rate, though it might be difficult to implement such a system in the United States.

Our prostatic fates may not be in our biopsies but in our MRIs.

Active Surveillance Patient International Sept. 30 webinar on lifestyle and low-risk PCa

By Howard Wolinsky

During September's Prostate Cancer Awareness Month, Active Surveillance Patients International (ASPI) sponsors a free webinar on lifestyle research and low-risk prostate cancer from 12-1:30 p.m. Eastern, Saturday Sept. 30.

Register here for “Applied Research and Lifestyles and Low-Risk Prostate Cancer," for: https://zoom.us/meeting/register/tJwvdOGoqjwuE9CC8AI45nYdsj63e-iUnop6

(Dr. June Chan, UCSF.)

The program focuses on how men can take some control over their lifestyle, including eating, exercise, and exposure to known carcinogens. The program also will cover how mental health behavior may help the patient adhere to a healthy lifestyle. Please submit any questions ahead of the program to: contactus@aspatients.org.            

The program includes:

—Dr. June Chan, of UCSF, on “The Role of Exercise for Deterring Prostate Cancer Progression/Death”;

—Dr. Stacy Kenfield, of UCSF, on “The Role of Diet for Men Living with Prostate Cancer”;

—Chan on “Lifestyle Scores & Prostate Cancer Progression”;

—UCSF dietitician Greta Macaire on “Practical Advice on Diet for Men Living with Prostate Cancer”;

(UCSF dietitian Greta Macaire)

—PA-C Christina Nakamoto, Medical Science Liaison for Urology at Myriad Genetics Inc., will cover cancer causes, such as carcinogens/diet/ hereditary, and mental health mindfulness for cancer.

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Join trailblazing researcher Dr. Laurence Klotz in a webinar on focal therapy on Aug. 31

Dr. Laurence Klotz, of the University of Toronto, one of the fathers of active surveillance, also is a pioneer in focal therapy, methods to remove lesions without performing radical prostatectomies.

He will share his experience in a free webinar at 8-9:30 p.m. August 31 entitled, "Is focal therapy right for your prostate cancer?" Register at https://attendee.gotowebinar.com/register/1495697985984134744

Send questions in advance to Joe Gallo at joeg@ancan.org,

You should leave the program with an understanding of whether you are a candidate—or not—for focal therapy. FT’s not for everyone.

Focal therapy offers middle-ground therapy for men with localized prostate cancer. It uses ablation, or tissue destruction, to target the area that contains the index lesion. Men who have focal therapy will continue to be monitored after treatment.

This program is aimed at the newly diagnosed who are considering options and those who are considering leaving Active Surveillance.

If you can’t make it, register, and you’ll automatically get the link to the video link.

Laughing your prostate off in the Gleason awards

By Howard Wolinsky

Submit your prostate jokes, cartoons, limericks, whatever—on DREs, PSAs, BPH, and prostatitis—to The Gleasons—Putting The Glee In Gleason Scores, the first prostate humor contest.

The contest, started by Jim-Bob Williams, a therapeutic humorist and Gleason 6 patient, and me, is open to doctors and patients alike. The deadline is Sept. 1.

Share your prostate humor at howard.wolinsky@gmail.com Jokes, limericks, poems, whatever floats your boat. We do play blue so ED and Viagra jokes are in play.

A distinguished panel will announce the winners later in September, Prostate Cancer Awareness Month.

(Sir Billy.)

In the professional division, AnCan Foundation has nominated Sir Billy Connolly’s over-the-top prostate exam bit: https://ancan.org/billy-connolly-prostate-examination/

Guaranteed that you’ll laugh your prostate—and ass—off.