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

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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.

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Acknowledgements

Sachinka Ranasinghe for assistance with data collection.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia

    Peter Donato, Andrew Morton, John Yaxley, Patrick E. Teloken, Geoff Coughlin, Rachel Esler, Nigel Dunglison, Robert A. Gardiner & Matthew J. Roberts

  2. Faculty of Medicine, The University of Queensland, Herston, QLD, 4029, Australia

    Peter Donato, Andrew Morton, John Yaxley, Patrick E. Teloken, Robert A. Gardiner & Matthew J. Roberts

  3. Wesley Urology Clinic, Brisbane, Australia

    John Yaxley, Geoff Coughlin, Rachel Esler & Nigel Dunglison

  4. Griffith University, Queensland, Australia

    Robert A. Gardiner

  5. Edith Cowan University, Joondalup, WA, Australia

    Robert A. Gardiner

  6. Nepean Urology Research Group, Kingswood, NSW, Australia

    Matthew J. Roberts

Authors
  1. Peter Donato
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  2. Andrew Morton
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  3. John Yaxley
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  4. Patrick E. Teloken
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  6. Rachel Esler
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  7. Nigel Dunglison
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  8. Robert A. Gardiner
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  9. Matthew J. Roberts
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Contributions

PD: protocol development, data collection, management and analysis, and manuscript writing. AM: data collection and management. JY: protocol/project development and manuscript editing. PET: data management and manuscript editing. GC: protocol/project development and manuscript editing. RE: protocol/project development and manuscript editing. ND: protocol/project development and manuscript editing. RAG: protocol/project development and manuscript editing. MJR: protocol/project development, data management and analysis, and manuscript writing and editing.

Corresponding author

Correspondence to Matthew J. Roberts.

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Donato, P., Morton, A., Yaxley, J. et al. Improved detection and reduced biopsies: the effect of a multiparametric magnetic resonance imaging-based triage prostate cancer pathway in a public teaching hospital. World J Urol 38, 371–379 (2020). https://doi.org/10.1007/s00345-019-02774-y

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  • DOI: https://doi.org/10.1007/s00345-019-02774-y

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