Prostate Biopsy in Men with an Elevated PSA Level - Reducing Overdiagnosis.

The article discusses the use of magnetic resonance imaging (MRI) in reducing overdiagnosis of prostate cancer in men with elevated prostate-specific antigen (PSA) levels. Initially, there was hesitation in using active surveillance for low-grade disease due to concerns about missing high-grade disease. However, recent studies have shown that MRI can help detect high-grade disease with targeted biopsies, reducing the need for systematic biopsies. The article presents the findings of the Swedish GOTEBORG-2 trial, which showed a lower risk of detecting low-grade disease and a lower proportion of men with higher-grade disease in the MRI-targeted biopsy group compared to the systematic biopsy group. However, the MRI-targeted biopsy approach also led to a delay in diagnosing higher-grade disease in some men. The article concludes that performing MRI in everyone with an elevated PSA level is resource-intensive, but the experimental approach used in the trial minimized the number and extent of biopsies. Overall, the use of MRI in the context of PSA-based screening is evolving, and further research is needed to determine the most effective and cost-efficient strategies. [Extracted from the article]