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Invited Commentary
February 4, 2021

Choosing the Right Diagnostic Pathway in Biopsy-Naive Patients With Suspected Prostate Cancer

Author Affiliations
  • 1Hospices civils de Lyon, Department of Urinary and Vascular Imaging, Hôpital Édouard-Herriot, Lyon, France
  • 2Faculté de médecine Lyon Est, Université Lyon 1, Université de Lyon, Lyon, France
JAMA Oncol. 2021;7(4):542-543. doi:10.1001/jamaoncol.2020.7578

In the prospective multicenter Prostate Evaluation for Clinically Important Disease: Sampling Using Image-Guidance or Not? (PRECISION) trial,1 500 biopsy-naive patients with suspected prostate cancer were randomly assigned to either classical 10- to 12-core systematic biopsy or to magnetic resonance imaging (MRI) and targeted biopsy without systematic biopsy if MRI was suggestive of cancer. The detection rate for cancers with an International Society of Urological Pathology (ISUP) grade 2 or higher was significantly higher in men assigned to MRI and targeted biopsy (38%) than in those assigned to systematic biopsy (26%; P = .005). In addition, overdiagnosis of ISUP grade 1 cancer was reduced in the MRI-targeted biopsy group (9% vs 22%, P < .001), and 28% of men in this group avoided biopsy.

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