Could a ‘Manogram’ Replace a Prostate Biopsy?

Could imaging replace a painful biopsy in testing for prostate cancer?

Such is the vision of Jelle Barentsz, MD, PhD, from the Radboud University Medical Center in Nijmegen, the Netherlands, who recently presented data to support the use of a fast biparametric (bp) MRI technique for prostate imaging.

He positioned this as a first step in the workup for patients whose prostate-specific antigen (PSA) level is found to be elevated. Such imaging could spare men from the pain and complications of a prostate biopsy, at least in this first instance.

Barentsz proposed the term “manography.”

This could make MRI of the prostate for men of a certain age as routine as mammography screening for breast cancer is for women of a certain age, he suggested.

“MRI can be fast, noninvasive, accurate, and potentially less expensive [than biopsies],” Barentsz said.

When I first learned about this as-yet unrealized promise of using MRI as a routine screening modality for prostate cancer, offering the tantalizing prospect of avoiding biopsies, I thought, “sign me up!”

I speak as a 62-year-old who has been lucky enough to have had three — count ’em, three — ultrasound-guided prostate biopsies, all of which, fortunately, came back negative.

Given my family history and my high-normal levels of PSA, I discussed it with my primary care physician, and we agreed that it made sense for me to “man up” and have the biopsies.

Looking for Trouble

Screening for prostate cancer with the PSA blood test was once widespread in the United States but is now controversial.

Concerns over potential harms from overdiagnosis of lesions that may never spread led to recommendations against routine use of the PSA test.

PSA itself is a notoriously fickle marker that can be affected by many different factors, such as sexual intercourse, exercise, and diet, as reported by Medscape Medical News earlier this year.

The US Preventive Services Task Force (USPSTF) issued a statement that is lukewarm at best regarding prostate cancer screening for men in my age group — 55 to 69 years. The statement reads, in part, as follows:

“In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening.”

The statement doesn’t fudge when it comes to older men, however: “The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older.”

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https://www.medscape.com/viewarticle/916297