No prostate biopsy without a positive MRI

The European Association of Urology’s Guidelines Office has formally announced a change in its guidance on how to diagnose prostate cancer. The guidelines now recommend there should be no prostate biopsies without a positive multiparametric MRI beforehand.  

The change takes into account recent research, and aims to improve diagnostic accuracy and prevent unnecessary interventions. Speaking at a guideline meeting during the EAU Congress, Professor Caroline Moore, Reader in Urology from University College London, said there was no doubt that standard biopsy in men with a negative MRI can have unfortunate results.

Caroline Moore

“Side-effects of biopsy are common, and current treatment rates are much higher than recommended,” she said. ““Five-year detection rates of significant cancer in men with negative MRI and no TRUS biopsy are low. I recommend that we hold fire, rather than end-fire.”

According to Europa Uomo’s Secretary, John Dowling, who was at the meeting, a welcome feature of the discussion was the emphasis on the patient being involved in decisions whether or not to perform a biopsy if the MRI proves negative.

Caroline Moore said: “Discussion with the patient is important and I’m pleased to see that in the 2019 EAU Guidelines. It’s a recognition that this is a preference-sensitive decision. A man might prefer greater certainty at the expense of side-effects and expense. Or he might be very confident in the fact we’re not missing the sort of disease that might impact his life and be happier to forego the biopsy.”

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