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Prostate Cancer Screening: Is There a Better Way?

Half of the men will, like millions of American men, undergo standard PSA testing and receive a biopsy if the PSA is elevated. The other men will get the same PSA testing, and then will undergo mpMRI, a painless, noninvasive procedure, before biopsy.

Prostate cancer screening is not specific enough — even though there are new tools today that might reduce the risk of over-diagnosis, says urologist Ashley Ross, M.D., Ph.D. He believes that one diagnostic test, in particular, shows great promise: "Multi-parametric" MRI (mpMRI), which can show clinically significant cancer. "Though mpMRI is being integrated into clinical practice, it has not been rigorously compared to standard prostate cancer screening," he says. How good is it? Ross, with co-investigators H. Ballentine Carter and Craig Pollack, aims to find out. "Our hypothesis is that using mpMRI in men with elevated PSA may decrease unnecessary biopsies and the diagnosis of clinically insignificant prostate cancer — which doesn't need to be treated — with minimal under- diagnosis of clinically significant cancer."

To do this, Ross and colleagues will design and perform a randomized trial. Half of the men will be those who, like millions of American men, undergo standard PSA testing and receive a transrectal ultrasound biopsy if the PSA is elevated. The other group of men will get the same PSA testing, and then will undergo mpMRI, a painless, noninvasive procedure, before biopsy. "For those undergoing MRI and then biopsy, biopsy will be performed with MRI- ultrasound fusion technology." In addition, the group will assess the usefulness of biomarkers that recently have come into clinical practice, and determine the cost-effectiveness of the two screening strategies. "The results of this trial will have immediate implications as to how we screen men for prostate cancer."

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