Re: Diagnostic Accuracy of Multi-parametric MRI and TRUS Biopsy in Prostate Cancer (PROMIS): A Paired Validating Confirmatory Study.

Experts’ summary: This much-anticipated study reports the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI)– and transrectal ultrasound (TRUS)–guided biopsy of the prostate compared to a reference standard of transperineal mapping (TPM) biopsy of the prostate in men with a suspicion of prostate cancer. In a prospective multicenter study, the authors enrolled 740 men, 576 of whom underwent 1.5-T mpMRI followed by both TRUS biopsy and TPM biopsy. On TPM biopsy, 408/576 men (71%) had cancer, with 230/576 patients (40%) deemed to have ‘‘clinically significant’’ disease (Gleason grade group 3 or above, or maximum core length >5 mm). For clinically significant cancer, mpMRI was more sensitive (93%, 95% confidence interval [CI] 88–96%) than TRUS biopsy (48%, 95% CI 42–55%; p < 0.0001) and less specific (41%, 95% CI 36–46% for MP-MRI vs 96%, 95% CI 94–98% for TRUS biopsy; p < 0.0001). The authors conclude that 27% of patients might avoid a biopsy if mpMRI was embraced in the diagnostic protocol for detection of clinically significant prostate cancer.