The use of risk assessment with MRI before biopsy and MRI-targeted biopsy was superior to standard transrectal ultrasonography-guided biopsy in men at clinical risk for prostate cancer who had not undergone biopsy previously. (Funded by the National Institute for Health Research and the European Association of Urology Research Foundation; PRECISION ClinicalTrials.gov number, NCT02380027 .).

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The combined transurethral treatment of BPH associated with bladder lithiasis by means of GreenLight laser vaporization and holmium laser lithotripsy on an outpatient basis can be performed safely and yields excellent results.

INTRODUCTION AND OBJECTIVES: Due to the growing concerns of over-diagnosis and limitations of conventional transrectal ultrasound guided (TRUS) biopsy, multi-parametric magnetic resonance imaging of the prostate (MP-MRI prostate) may improve the accuracy in detecting clinically significant prostate cancer. With the national trends in MP-MRI prostate utilization poorly described, we sought to elucidate its adoption among patients undergoing a prostate cancer screening and subsequent diagnosis of elevated prostate specific antigen (PSA) in a large privately insured population-based cohort.METHODS: From a large private health insurance database (OptumLabs), we identified men age 40-80 years screened for prostate cancer through PSA testing from January 2010 to December 2016. In addition, the men had to have a diagnosis of enlarged prostate or elevated PSA within 14 days after the screening date. Use of MP-MRI of the prostate and biopsies within the 30 days post diagnosis were collected. Unadjusted, age-specific and age-adjusted annual rates of MRIs over time were analyzed for trends using regression models (trend analysis).RESULTS: We identified 1,018,558 screenings for prostate cancer performed on men age 40-80 years from 2010 to 2016 with a subsequent diagnosis of elevated PSA within 14 days of the PSA test. Overall mean (standard deviation) age was 64.3 (9.5) years. The majority were white (53%); however, 31% were documented as race-unknown. A small proportion went on to have a prostate biopsy (3.9%). Unadjusted annual rates of MRI among those with biopsy significantly increased over time from 5.2 per 1,000 biopsies in 2010 to 13.5 in 2016 (p¼0.0075 for trend). Similarly, annual age-adjusted rates of MRI significantly increased from 5.5 per 1,000 biopsies in 2010 to 13.5 in 2016 (p¼0.0083 for trend). Age-specific rates also increased for all age groups (40-49, 50-59, 60-65, 66-75 and 75þ). The largest and only significant increase was in the age 60-65 group which increased from 4.4 in 2010 to 16.0 in 2016 (p¼0.005 for trend).CONCLUSIONS: Contemporary trends of MP-MRI prostate at the time of biopsy has increased markedly among privately insured patients in the U.S.