BACKGROUND: Transrectal ultrasound-guided prostate biopsies are prone to detection errors.
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Multi-parametric MRI (MP-MRI) may improve the diagnostic pathway.
METHODS: PROMIS is a prospective validating paired-cohort study that meets criteria for level 1 evidence in diagnostic test evaluation. PROMIS will investigate whether multi-parametric (MP)-MRI can discriminate between men with and without clinically-significant prostate cancer who are at risk prior to first biopsy. Up to 714 men will have MP-MRI (index), 10-12 core TRUS-biopsy (standard) and 5mm transperineal template mapping (TPM) biopsies (reference). The conduct and reporting of each test will be blinded to the others.
RESULTS: PROMIS will measure and compare sensitivity, specificity, and positive and negative predictive values of both MP-MRI and TRUS-biopsy against TPM biopsies. The MP-MRI results will be used to determine the proportion of men who could safely avoid biopsy without compromising detection of clinically-significant cancers. For the primary outcome, significant cancer on TPM is defined as Gleason grade>/=4+3 and/or maximum cancer core length of ≥6mm. PROMIS will also assess inter-observer variability among radiologists among other secondary outcomes. Cost-effectiveness of MP-MRI prior to biopsy will also be evaluated.
CONCLUSIONS: PROMIS will determine whether MP-MRI of the prostate prior to first biopsy improves the detection accuracy of clinically-significant cancer.
El-Shater Bosaily A, Parker C, Brown LC, Gabe R, Hindley RG, Kaplan R, Emberton M, Ahmed HU. Are you the author?
Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK; Department of Academic Urology, Royal Marsden Hospital, Sutton, UK; MRC Clinical Trials Unit at UCL, UK; Department of Health Sciences, University of York, UK; Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK.
Reference: Contemp Clin Trials. 2015 Mar 3;42:26-40.