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Combining Prostate MRI with Blood Test Can Avoid Unnecessary Prostate Biopsies
By MedImaging International staff writers Posted on 01 Apr 2024
Image: Unnecessary prostate biopsies can be avoided by combining MRI of the prostate findings with PSA density (Photo courtesy of 123RF)
Prostate cancer ranks as the second most prevalent cancer among men globally. For a long time, researchers have acknowledged that not every instance of prostate cancer poses a danger that warrants immediate treatment or even a biopsy. Clinically significant prostate cancer (csPCa) is identified as cancer with a higher likelihood of becoming life-threatening, characterized by cells that appear more aggressive or cancer found outside of the prostate gland. Differentiating which cancers necessitate treatment without conducting a biopsy presents a challenge. Traditional biopsies are required to assess the aggressiveness of cancer cells, yet these procedures can be uncomfortable, invasive, and costly. Now, new research suggests that combining an MRI of the prostate with a blood test could effectively identify clinically significant prostate cancers.
Investigators from Brigham and Women’s Hospital (Boston, MA, USA) have suggested that unnecessary prostate biopsies can be avoided by combining MRI findings with prostate-specific antigen (PSA) density measurements. This novel diagnostic strategy aims to minimize the harm and healthcare costs associated with prostate biopsies. The study explored a new methodology that correlates MRI-based prostate imaging reporting and data system (PI-RADS) scores with PSA density (PSAD) to identify cancers likely to be clinically significant without biopsy data. PI-RADS assesses prostate lesions on a scale from 1 (unlikely to be clinically significant) to 5 (high likelihood of being clinically significant). PSAD is calculated by dividing the PSA level by the volume of the prostate, as determined via MRI.
Building on earlier research conducted exclusively at Brigham Women's Hospital, which suggested that PI-RADS and PSAD thresholds could eliminate the need for biopsies in up to half of the cases, the recent study analyzed data from 72 published studies encompassing over 36,000 men with prostate cancer. This analysis aimed to validate whether the initial findings could be generalized across a broader population. Results indicated that prostate biopsies might be redundant for patients with PI-RADS scores below 4 and PSAD less than 0.10 ng/ml2. Utilizing specific PI-RADS and PSAD thresholds, it was determined that 50% of biopsies could be omitted, risking the miss of only 5% of clinically significant cancers, or alternatively, skip 30% of biopsies and miss just 3% of such cancers. The research team plans to develop an easy-to-use patient-level scoring system that would enable urologists to more accurately evaluate the need for a biopsy.
"In the workup of men suspected of having prostate cancer, prostate MRI findings combined with PSA density measurement can help doctors decide which patients to biopsy," said senior author Ramin Khorasani, MD, MPH, Radiology Vice Chair for Quality and Safety at Brigham and Women’s Hospital and Mass General Brigham and Philip H. Cook Professor of Radiology at Harvard Medical School. "With this new analysis, we looked to see how MRI can help urologists decide which patients to biopsy and which patients may not need aggressive diagnosis and treatment."
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(40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 187
(!!!!! 3721.9524383545): SELECT fid FROM jos_deeppockets
WHERE cat=10
AND id=294800721
AND (type='deeppockets_item' OR type='deeppockets_item_link')
AND published='1'
LIMIT 188
(49.114227294922): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800721 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 189
(56.028366088867): SELECT id,name,title
FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1
AND id != 294743300
AND id != 294743301
AND id != 294743302
AND id != 294743303
AND id != 294743304
AND id != 294743305
AND id != 294743306
AND id != 294743307
AND id != 294743308
AND id != 294743309
AND id != 294743310
AND metakey != 'aacc'
ORDER BY `ordering`90
(!!!!! 4441.0228729248): SELECT show_live FROM jos_com_show_setting LIMIT 191
(49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 192
(30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 193
(28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 194
(36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 195
(29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 196
(30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 197
(95.129013061523): SELECT show_live FROM jos_com_show_setting LIMIT 198
(122.7855682373): SELECT show_live FROM jos_com_show_setting LIMIT 199
(30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1100
(67.949295043945): SELECT show_live FROM jos_com_show_setting LIMIT 1101
(97.990036010742): SELECT show_live FROM jos_com_show_setting LIMIT 1102
(68.902969360352): SELECT show_live FROM jos_com_show_setting LIMIT 1103
(82.969665527344): SELECT show_live FROM jos_com_show_setting LIMIT 1104
(986.09924316406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1105
(56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1106
(139.95170593262): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp
LEFT JOIN jos_experts as exp
ON exp.id = dp.author
LEFT JOIN jos_deeppockets as ch
ON dp.fid = ch.id
WHERE 1=1
AND dp.cat=10
AND dp.id=294800721
AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
AND dp.published='1' LIMIT 1107
(711.91787719727): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp
LEFT JOIN jos_experts as exp
ON exp.id = dp.author
LEFT JOIN jos_deeppockets as ch
ON dp.fid = ch.id
WHERE 1=1
AND dp.cat=10
AND dp.id=294800721
AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
AND dp.published='1' LIMIT 1108
(935.07766723633): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1109
(60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1110
(71.048736572266): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp
LEFT JOIN jos_experts as exp
ON exp.id = dp.author
LEFT JOIN jos_deeppockets as ch
ON dp.fid = ch.id
WHERE 1=1
AND dp.id=294800721
AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
AND dp.published='1' LIMIT 1111
(!!!!! 1281.0230255127): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp
LEFT JOIN jos_experts as exp
ON exp.id = dp.author
LEFT JOIN jos_deeppockets as ch
ON dp.fid = ch.id
WHERE 1=1
AND dp.id=294800721
AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
AND dp.published='1' LIMIT 1112
(!!!!! 6332.8742980957): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp
LEFT JOIN jos_experts as ex
ON ex.id = dp.author
LEFT JOIN jos_deeppockets as dp2
ON dp2.id = dp.fid
WHERE dp.author != 0
AND dp.cat = 10
AND dp.published = 1
AND (
(dp.fid = 294743300)
OR (dp.fid = 294743301)
OR (dp.fid = 294743302)
OR (dp.fid = 294743303)
OR (dp.fid = 294743304)
OR (dp.fid = 294743305)
OR (dp.fid = 294743306)
OR (dp.fid = 294743307)
OR (dp.fid = 294743308)
OR (dp.fid = 294743309)
OR (dp.fid = 294743310)
)
ORDER BY RAND()
LIMIT 1113
(!!!!! 1962.9001617432): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp
LEFT JOIN jos_experts as ex
ON ex.id = dp.author
LEFT JOIN jos_deeppockets as dp2
ON dp2.id = dp.fid
WHERE dp.author != 0
AND dp.cat = 10
AND dp.published = 1
AND (
(dp.fid = 294743300)
OR (dp.fid = 294743301)
OR (dp.fid = 294743302)
OR (dp.fid = 294743303)
OR (dp.fid = 294743304)
OR (dp.fid = 294743305)
OR (dp.fid = 294743306)
OR (dp.fid = 294743307)
OR (dp.fid = 294743308)
OR (dp.fid = 294743309)
OR (dp.fid = 294743310)
)
ORDER BY RAND()
LIMIT 1114
(!!!!! 7127.046585083): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1115
(!!!!! 8008.0032348633): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1116
(!!!!! 7617.9504394531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1117
(!!!!! 4451.0364532471): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1118
(833.03451538086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1119
(118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1120
(339.03121948242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1121
(225.06713867188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1122
(514.03045654297): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`123
(!!!!! 69152.83203125): SELECT
*
FROM
jos_deeppockets
WHERE
jos_deeppockets.cat = 10
AND
jos_deeppockets.type = 'deeppockets_item'
AND
jos_deeppockets.published = 1
AND
jos_deeppockets.created + INTERVAL 14 DAY >= NOW()
ORDER BY
jos_deeppockets.hits DESC
LIMIT
7124
(!!!!! 7499.9332427979): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800721 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800721 AND type='deeppockets_item' AND published='1' LIMIT 1125
(!!!!! 36355.018615723): (
SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.video != ''
AND
dp.video_source != ''
AND
dp.cat = 10
AND
dp.published = 1
AND
dp.type != 'deeppockets_item_link'
ORDER BY
created DESC
LIMIT
3
)
UNION
(
SELECT
dpa.id,
dpa.name,
dpa.title,
dpa.video,
dpa.video_source,
dpa.created
FROM
jos_deeppockets_archive AS dpa
WHERE
dpa.video != ''
AND
dpa.video_source != ''
AND
dpa.cat = 10
AND
dpa.published = 1
AND
dpa.type != 'deeppockets_item_link'
ORDER BY
created DESC
LIMIT
3
)
ORDER BY
created DESC
LIMIT
3126
(!!!!! 3519.0582275391): (
SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.video != ''
AND
dp.video_source != ''
AND
dp.cat = 10
AND
dp.published = 1
AND
dp.type != 'deeppockets_item_link'
ORDER BY
created DESC
LIMIT
3
)
UNION
(
SELECT
dpa.id,
dpa.name,
dpa.title,
dpa.video,
dpa.video_source,
dpa.created
FROM
jos_deeppockets_archive AS dpa
WHERE
dpa.video != ''
AND
dpa.video_source != ''
AND
dpa.cat = 10
AND
dpa.published = 1
AND
dpa.type != 'deeppockets_item_link'
ORDER BY
created DESC
LIMIT
3
)
ORDER BY
created DESC
LIMIT
3127
(577.92663574219): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.id = 294803337
LIMIT 1128
(45.061111450195): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.id = 294803337
LIMIT 1129
(502.10952758789): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.id = 294803276
LIMIT 1130
(191.92695617676): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.id = 294803276
LIMIT 1131
(264.16778564453): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets_archive AS dp
WHERE
dp.id = 294803276
LIMIT 1132
(120.87821960449): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets_archive AS dp
WHERE
dp.id = 294803276
LIMIT 1133
(485.89706420898): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.id = 294802958
LIMIT 1134
(39.815902709961): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.id = 294802958
LIMIT 1135
(305.8910369873): SELECT *
FROM jos_deeppockets
WHERE 1=1
AND id=294800721
AND (type='deeppockets_item' OR type='deeppockets_item_link')
AND published='1'
LIMIT 1136
(635.14709472656): SELECT *
FROM jos_deeppockets_archive
WHERE 1=1
AND id=294800721
AND (type='deeppockets_item' OR type='deeppockets_item_link')
AND published='1'
LIMIT 1137
(451.08795166016): SELECT name FROM jos_deeppockets WHERE id=212138
(37.908554077148): SELECT name FROM jos_deeppockets WHERE id=212139
(722.88513183594): SELECT *,
DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up,
DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down
FROM jos_events
WHERE state=1
AND publish_up > NOW()
and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110)
ORDER BY publish_up ASC LIMIT 3140
(!!!!! 1106.0237884521): SELECT *,
DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up,
DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down
FROM jos_events
WHERE state=1
AND publish_up > NOW()
and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110)
ORDER BY publish_up ASC LIMIT 3141
(834.94186401367): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1142
(!!!!! 2596.8551635742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1143
(!!!!! 8224.9641418457): TRUNCATE TABLE jos_trademed_module144
(!!!!! 13046.979904175): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp
LEFT JOIN jos_experts as exp
ON exp.id = dp.author
LEFT JOIN jos_deeppockets as ch
ON dp.fid = ch.id
WHERE 1=1
AND dp.cat=10
AND dp.id=294800721
AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
AND dp.published='1' LIMIT 1145
(324.01084899902): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp
LEFT JOIN jos_experts as exp
ON exp.id = dp.author
LEFT JOIN jos_deeppockets as ch
ON dp.fid = ch.id
WHERE 1=1
AND dp.cat=10
AND dp.id=294800721
AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
AND dp.published='1' LIMIT 1146
(406.02684020996): SELECT *
FROM jos_deeppockets
WHERE 1=1
AND id=294800721
AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1147
(58.889389038086): SELECT *
FROM jos_deeppockets
WHERE 1=1
AND id=294800721
AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1148
(352.14424133301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1149
(111.10305786133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1150
(!!!!! 2652.1682739258): SELECT jos_item.*
FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id
WHERE 1=1
AND (jos_item.imgMini<>'')
AND jos_item.type='L'
AND jos_item.numberID= (
SELECT jos_number.id
FROM jos_number
WHERE jos_number.journalID IN (10)
and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P')
ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC
LIMIT 0,1
)
ORDER BY RAND() DESC LIMIT 6151
(254.86946105957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1152
(293.01643371582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1153
(277.04238891602): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800721 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800721 AND type='deeppockets_item' AND published='1' LIMIT 1154
(97.036361694336): select distinct links.*
from jos_textlinks links
join jos_textlinks_placement placement on links.id=placement.link_id
where journal_id=(10) and (channel_id=212 or channel_id is null)155
(84.877014160156): select distinct links.*
from jos_textlinks links
join jos_textlinks_placement placement on links.id=placement.link_id
where journal_id=(10) and (channel_id=212 or channel_id is null)156
(!!!!! 2398.0140686035): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1157
(66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1158
(117.06352233887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800721 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800721 AND published='1'
LIMIT 1159
(614.16625976562): select jos_twitters.link from jos_twitters where cat=10160
(136.13700866699): select jos_facebook.link from jos_facebook where cat=10161
(31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10162
(28.848648071289): select jos_linkedin.link from jos_linkedin where cat=10163
(799.17907714844): update jos_bannersmanager_banner
set impmade=impmade+1
where id in(14615,14202,14203)164
(!!!!! 1172.0657348633): insert into jos_banners_delta values (14615,'2025-08-25 11:17:58','216.73.216.114','view'),(14202,'2025-08-25 11:17:58','216.73.216.114','view'),(14203,'2025-08-25 11:17:58','216.73.216.114','view')
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