PRECISION

PRECISION, trial NCT02380027 sponsored by UCL and reported in 2018, proved that doing an MRI first, and biopsying only if the scan is positive, finds more dangerous prostate cancers with fewer biopsies than standard transrectal ultrasound biopsy. It randomised 500 biopsy-naive men with a raised PSA, detected clinically significant cancer in 38 percent with MRI-targeted biopsy against 26 percent with standard biopsy, found fewer insignificant cancers and let 28 percent of men avoid biopsy, changing guidelines worldwide. OnCo links it to multiparametric prostate MRI, MRI-first screening, Mark Emberton and Hashim U. Ahmed, and to the bottleneck of overdiagnosis; its findings were confirmed by PRECISE, MRI-FIRST and the Göteborg-2 screening trial. Whether MRI-first pathways can be delivered at population scale with consistent reading quality is the open question.