“Discussing the role of MRI” -Platinum Opinion of Vickers and replies-

 


 

 

Platinum Opinion:

Routine Use of Magnetic Resonance Imaging for Early Detection of Prostate Cancer Is Not Justified by the Clinical Trial Evidence

 By: Vickers et al

“The routine use of MRI in-biopsy naïve men for detection of prostate cancer is not justified at present.”


 

Platinum Priority editorial:

Pre-biopsy MRI: Through the Looking Glass

By: EAU-EANM-ESTRO-ESUR-SIOG Prostate Cancer Guideline Panel

“There is clear evidence that MRI and TB improve the detection of GG >2 cancer over SB. This higher rate should be interpreted with care. Some detected cancers may correspond to small cancers as a result of stage/grade migration, while others may be aggressive tumours that would otherwise have been missed. The urological community should adapt risk classification to correctly separate the wheat from the chaff in the MRI era. Importantly, growing evidence suggests that MRI, combined with clinical data, could also help in selecting patients with very low-risk cancer who do not need to undergo biopsy at all. The advantages of using pre-biopsy MRI outweigh the suggested harms.” 


 

Reply of Vickers et al.:

Pre-biopsy MRI: Through the Looking Glass

By: Vickers et al

“Neither the clear and obvious value of MRI in certain clinical indications, such as persistently elevated or rising PSA after a negative biopsy, the “potential” of MRI to reduce unnecessary biopsy nor the possibility that MRI could mitigate overtreatment (pending changes in guide-lines) warrants the routine use of pre-biopsy MRI at the current time.”


 

Platinum Opinion Counter view:

The Evidence Base for the Benefit of the MRI-directed Prostate Cancer Diagnosis is Sound

By: Padhani et al

MRI-directed diagnosis of prostate cancer represents a paradigm shift for early detection of clinically relevant prostate cancers based on sound level 1 evidence. Pre-biopsy prostate MRI has a negative predictive value of 91% for noninvasively ruling out GG >2 cancers, with a narrow 95%-CI (88.1–93.1%).

Therefore, the focus of Vickers et al. on the lack of superiority of MRI in ruling in GG >2 cancers miss the point. Also, their statement replying the EAU-EANM-ESTRO-ESUR-SIOG Prostate Cancer Guideline Panel that the routine use of pre-biopsy MRI at the current time is not warranted conflicts with the level 1A evidence papers that show at least a 30% reduction of unnecessary SB and the above mentioned 91% NPV.”

1. Vickers Cooperberg Carlsson

1.Platinum Opinion:
Routine Use of Magnetic Resonance Imaging for Early Detection of Prostate Cancer Is Not Justified by the Clinical Trial Evidence.
By Vickers et al.

2. Reply to Vickers et al.

2. Platinum Priority editorial:
Prebiopsy MRI: Through the Looking Glass.
By: EAU-EANM-ESTRO-ESUR-SIOG Prostate Cancer.

3. Reply to Reply Vickers et al

3. Reply:
By Vickers et al. to Platinum Priority editorial: Prebiopsy MRI: Through the Looking Glass.
By: Vickers et al.

4. Platinum Opinion Counterview to Vickers

4. Platinum Opinion Counterview:
The Evidence Base for the Benefit of Magnetic Resonance Imaging-directed Prostate Cancer Diagnosis is Sound.
By: Padhani et al

Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know

Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know.

Download here: 3-Papers-In-1

ESUR prostate MR guidelines 2012

This paper describes PI-RADS v1

NEJM prostate cancer MR lymph-node contrast

First paper, that describes the potential of Combidex to recognise small nodal metastases.

Updates on these papers

PI-RADS V2

Full PIRADS v2 paper.

PI-RADS v2.1

PI-RADS v2.1

Combidex MRI in Prostate Cancer

MRI with a lymph-node-specific contrast agent as an
alternative to CT scan and lymph-node dissection in patients
with prostate cancer: a prospective multicohort study.

Papers on mpMRI

Radiology MRI-pathway

Radiology Padhani et al MRI-pathway

Drost et al-2019-Cochrane Database of Systematic Reviews

Cochrane Review on MRI Pathway in detecting significant PCa

4M MRI vs TRUS

"4M Study" van der Leest et al. mpMRI vs TRUGB

bp-MRI Eur Urol 2019

"4M Study" van der Leest et al. Fast non-contrast bpMRI

Web of Science

298 publications

 

see also 

Researcher-ID: D-3515-2009

 

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