Improved detection and reduced biopsies: The effect of a multiparametric magnetic resonance imaging-based triage prostate cancer pathway in a public teaching hospital

Document Type

Journal Article

Publication Title

World Journal of Urology

Publisher

Springer

School

School of Medical and Health Sciences

RAS ID

33997

Comments

Donato, P., Morton, A., Yaxley, J., Teloken, P. E., Coughlin, G., Esler, R., ... & Roberts, M. J. (2020). Improved detection and reduced biopsies: The effect of a multiparametric magnetic resonance imaging-based triage prostate cancer pathway in a public teaching hospital. World Journal of Urology, 38(2), 371-379. https://doi.org/10.1007/s00345-019-02774-y

Abstract

Purpose: Multiparametric magnetic resonance imaging (mpMRI) improves clinically significant prostate cancer (csPCa) detection by facilitating targeted biopsy (cognitive, fusion technology, or in-gantry MRI guidance) and reducing negative biopsies. This study sought to describe the feasibility of introducing an mpMRI-based triage pathway, including diagnostic performance, applicability to training, and cost analysis. Methods: An observational retrospective cohort study of consecutive patients attending a large public tertiary referral training hospital who underwent mpMRI for suspicion of prostate cancer was considered. Standard clinical, MRI-related, histopathological, and financial parameters were collected for analysis of biopsy avoidance, diagnostic accuracy of biopsy approach, and operator (consultant and resident/registrar) and logistical (including financial) feasibility. Results: 653 men underwent mpMRI, of which 344 underwent prostate biopsy resulting in a 47% biopsy avoidance rate. Overall, 240 (69.8%) patients were diagnosed with PCa, of which 208 (60.5%) were clinically significant, with higher rates of csPCa observed for higher PIRADS scores. In patients who underwent both systematic and targeted biopsy (stTPB), targeted cores detected csPCa in 12.7% and 16.6% in more men than systematic cores in PIRADS 5 and 4, respectively, whereas systematic cores detected csPCa in 5% and 3.2% of patients, where targeted cores did not. A high standard of performance was maintained across the study period and the approach was shown to be cost effective. Conclusions: Introdution of an mpMRI-based triage system into a large public tertiary teaching hospital is feasible, cost effective and leads to high rates of prostate cancer diagnosis while reducing unnecessary biopsies and detection of insignificant PCa.

DOI

10.1007/s00345-019-02774-y

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