Frozen section analysis assisted MRI targeted prostate biopsy - results of the randomized clinical FAST trial.
Matthias Jahnen, Kristina Schwamborn, Andreas Sauter et al.
✦ AI-curated · Sources linked
In 30 seconds
The prospective randomized FAST trial compared frozen section analysis (FSA)-guided, primarily MRI-targeted prostate biopsy with standard combined targeted and systematic biopsy in men with PI-RADS ≥ 4 lesions. Among 160 randomized patients, clinically significant prostate cancer detection was 97% with the FSA-guided strategy and 93% with standard biopsy; the risk difference was 5.0% (95% CI -5.2-14.7), meeting the prespecified non-inferiority criterion. The median number of biopsy cores fell from 15 to 3, and several reported symptoms were less frequent in the experimental arm.
Key findings
- Clinically significant cancer detection was 97% with FSA-guided biopsy versus 93% with standard combined biopsy; risk difference 5.0% (95% CI -5.2-14.7).
- Median biopsy cores decreased from 15 with standard biopsy to 3 with the FSA-guided strategy (p < 0.001).
- Pain, discomfort, macrohematuria, and hematospermia were significantly lower in the experimental arm (all p < 0.05).
Why it matters
The trial suggests that immediate assessment of targeted cores may allow systematic sampling to be omitted when FSA is positive, while preserving detection of clinically significant disease in men with suspicious MRI lesions. Fewer cores and lower reported symptom burden could make biopsy less invasive, although the findings apply to the studied strategy and population.
What to keep in mind
The trial included 160 patients with PI-RADS ≥ 4 lesions; the abstract does not report longer-term oncological outcomes.