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Increasingly, urologists are using magnetic resonance imaging (MRI) to inform decisions about biopsy in men who undergo prostate-specific antigen (PSA) screening for prostate cancer. Presumably, biopsies targeted to MRI abnormalities — rather than systematic but nontargeted biopsies — could reduce overdiagnosis of clinically insignificant cancers.
This Swedish trial involved 18,000 men (age range, 50–60) who had PSA screening. The 1200 men with PSA levels ≥3 ng/mL underwent MRI and were randomized to two groups. In one group, only MRI-detected abnormalities (seen in ≈40% of participants) were biopsied. In the other group, men underwent both MRI-targeted and standard systematic 12-core biopsies. Key findings were as follows:
With the overall s…