{"entity":{"id":"paper-precision-mri-targeted-biopsy-nejm-2018","kind":"paper","name":"PRECISION: MRI-targeted or standard biopsy for prostate cancer diagnosis","aka":[],"tldr":"Doing an MRI first and biopsying only suspicious areas found more clinically significant prostate cancers and fewer harmless ones than standard biopsy, while sparing a quarter of men any biopsy at all.","summary":"Multicentre randomised non-inferiority trial of 500 biopsy-naive men with suspected prostate cancer randomised to MRI with targeted biopsy of suspicious lesions only (no biopsy if MRI was negative) or standard transrectal ultrasound-guided 10 to 12 core biopsy.\n\nClinically significant cancer was detected in 38 percent of the MRI group against 26 percent with standard biopsy, clinically insignificant cancer in 9 versus 22 percent, and 28 percent of MRI-group men avoided biopsy.","asOf":"2026-09-17","links":[{"label":"N Engl J Med 2018","url":"https://doi.org/10.1056/NEJMoa1801993"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/29552975/"}],"tags":[],"related":["prostate-roadmap","paper-ahmed-promis-multiparametric-mri-lancet-2017","paper-johnson-mpmri-individual-foci-eur-urol-2019","idea-prostate-per-lesion-mri-audit-before-focal-treatment"],"cancers":["prostate-low-risk","prostate"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["pi-rads","template-mapping-biopsy"],"trials":["precision-mri"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2018,"doi":"10.1056/NEJMoa1801993","pmid":"29552975","authors":"Kasivisvanathan V, Rannikko AS, Borghi M, et al.","paperType":"rct","findings":["Clinically significant cancer detected in 38 percent vs 26 percent.","Clinically insignificant cancer in 9 percent vs 22 percent; 28 percent of MRI arm avoided biopsy."],"whatItMeans":"Pre-biopsy MRI with targeted sampling is now the standard diagnostic pathway for suspected prostate cancer, reducing overdiagnosis of low-risk disease.","caveats":["Targeted biopsy alone may miss some significant cancers; many centres combine targeted and systematic cores.","Depends on MRI quality and reader expertise."],"changedPractice":true,"participants":500},"route":"/key-papers/paper-precision-mri-targeted-biopsy-nejm-2018/","neighbours":{"roadmap":[{"id":"prostate-roadmap","kind":"roadmap","name":"Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch","route":"/roadmaps/prostate-roadmap/"}],"paper":[{"id":"paper-johnson-mpmri-individual-foci-eur-urol-2019","kind":"paper","name":"Detection of individual prostate cancer foci via multiparametric magnetic resonance imaging","route":"/key-papers/paper-johnson-mpmri-individual-foci-eur-urol-2019/"},{"id":"paper-ahmed-promis-multiparametric-mri-lancet-2017","kind":"paper","name":"PROMIS: diagnostic accuracy of multiparametric MRI and TRUS biopsy in prostate cancer","route":"/key-papers/paper-ahmed-promis-multiparametric-mri-lancet-2017/"}],"idea":[{"id":"idea-prostate-per-lesion-mri-audit-before-focal-treatment","kind":"idea","name":"Publish a per-lesion miss rate for every prostate MRI service before it is allowed to guide focal treatment","route":"/ideas/idea-prostate-per-lesion-mri-audit-before-focal-treatment/"}],"cancer":[{"id":"prostate-low-risk","kind":"cancer","name":"Localised prostate cancer, very low and low risk","route":"/cancers/prostate-low-risk/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"term":[{"id":"pi-rads","kind":"term","name":"PI-RADS (Prostate Imaging Reporting and Data System)","route":"/terms/pi-rads/"},{"id":"template-mapping-biopsy","kind":"term","name":"Template mapping biopsy (transperineal template prostate mapping)","route":"/terms/template-mapping-biopsy/"}],"trial":[{"id":"precision-mri","kind":"trial","name":"PRECISION","route":"/trials/precision-mri/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}]}}