Magnetic resonance imaging (MRI) with or without prostate biopsy has become the international standard for diagnosing prostate cancer over the last five years, but research has found that widespread adoption has been challenging due to resource issues and increased demand.
There are two types of MRI procedures used to diagnose prostate cancer: multiparametric, composed of T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences; and biparametric, which does not have dynamic contrast-enhanced sequences.
Skipping the contrast step can cut overall procedure time in half to about 15–20 minutes and costs less because there’s no need for another health professional to be on hand in case of an allergic reaction.
For a study published this week in JAMA®, researchers examined whether biparametric MRI could be as good in diagnosing prostate cancer as MRI scans that include a contrast-injection sequence.
Here are the key points that radiologists, urologists, oncologists and other physicians need to know, as reported in the JAMA study, “Biparametric vs Multiparametric MRI for Prostate Cancer Diagnosis: The PRIME Diagnostic Clinical Trial.”
Question: Is biparametric MRI noninferior to multiparametric MRI in the detection of clinically significant prostate cancer?
Findings: In this level-1, prospective, multicenter, within-patient, noninferiority trial of 490 biopsy-naive men, biparametric MRI was noninferior to multiparametric MRI for detection of Gleason Grade Group 2 or higher prostate cancer (difference, −0.4 percentage points).
Meaning: In men with suspected prostate cancer, provided that image quality is adequate, an abbreviated biparametric MRI, with or without targeted biopsy, could become the new standard of care for prostate-cancer diagnosis.
A JAMA editorial published with the study lends perspective on the findings.
This trial “should update the standard of care in the diagnostic evaluation for prostate cancer,” says the editorial. “By reducing the time, cost, resources and invasiveness of MRI, transitioning to a biparametric approach has the potential to improve the patient’s experience and increase access to care.”
The finding, however, “comes with critical caveats that cannot be ignored as new clinical guidelines are considered,” and “the heterogeneity in image quality across imaging centers poses challenges for the real-world implementation of biparametric MRI, potentially leading to unpredictable results.”
AMA members can explore an entire range of cutting-edge, peer-reviewed research and clinical information. The JAMA Network™ is a world-class resource for the medical community. If you are an AMA member or interested in becoming one, learn how to access these educational materials and innovative tools.
Other notable findings in JAMA Network
“Race, Ethnicity, Insurance Payer, and Pediatric Cardiac Arrest Survival,” published in JAMA Network Open. In this retrospective cohort study of pediatric in-hospital cardiac arrest in a large, national, administrative dataset, children from historically marginalized racial and ethnic groups who received CPR had higher odds of in-hospital mortality. In addition, the odds of in-hospital mortality among children receiving CPR were higher at hospitals with the highest proportion of Black patients.
“High-Intensity Exercise and Hippocampal Integrity in Adults With Cannabis Use Disorder,” published in JAMA Psychiatry. This trial found that a 12-week, high-intensity interval training intervention did not improve hippocampal integrity or associated cognitive or mental health impairments while people continued to consume cannabis. However, results indicated that people with cannabis-use disorder can engage in regular physical exercise programs and highlighted exercise as a potential strategy to reduce cannabis craving.
What AMA members get with JAMA Network
The subscription cost of JAMA is included with your AMA membership, plus unlimited online and mobile access to all JAMA Network journals, including: JAMA, JAMA Network Open, JAMA Cardiology, JAMA Dermatology, JAMA Internal Medicine, JAMA Neurology, JAMA Oncology, JAMA Ophthalmology, JAMA Otolaryngology–Head and Neck Surgery, JAMA Pediatrics, JAMA Psychiatry, and JAMA Surgery.
The online journals include many helpful features for students, residents and fellows, including full-text PDFs, clinical challenges, archived editions, audio and video author interviews where authors give their perspectives on a study’s objectives, findings and implications.
There are several ways physicians can leverage resources from the JAMA Network to help them in their clinical practice:
- Take CME courses and earn AMA PRA Category 1 Credit™.
- Fulfill maintenance of licensure (MOL) and CME requirements on JN Learning™, the new home for all JAMA Network CME.
- Read concise summaries of clinical guidelines and recommendations in a streamlined format designed for today’s busy physicians.
- Access one-page articles that present key facts in patient-friendly terms to support you and your patients.
