Benefits of pre‐biopsy multi‐parametric magnetic resonance imaging scanning in the initial assessment of prostate cancer

Abstract

Traditionally, men referred for investigation of raised prostate specific antigen (PSA) could expect to be investigated via blind TRUS biopsy. In recent years, the availability of pre‐biopsy imaging with multi‐parametric magnetic resonance imaging (mp‐MRI) has allowed urology centres to improve their triage and care of this patient cohort. The ability to identify discrete lesions for more accurately targeted TRUS, stream patients with anterior lesions for trans‐perineal biopsy, and of course to prevent those with no evidence of clinically significant prostate cancer from being subjected to unnecessary procedures has proved pre‐biopsy mp‐MRI a valuable tool in the assessment and diagnosis of prostate cancer. Our service recently audited the impact of the introduction of mp‐MRI on our prostate cancer assessment pathway. An analysis of the outcomes of 1558 referrals over a 2‐year period, and found that pre‐biopsy imaging has resulted in a marked reduction in unnecessary procedures and more accurate targeting of lesions, leading to improved outcomes for patients.

Adherence to discharge protocols and prostate‐specific antigen surveillance plans in men without a prostate cancer diagnosis

“…11 Nurses are very much in the vanguard of prostate cancer diagnosis and care with nurse-led prostate cancer services becoming more common. 4 This means that nurses, whether they are based in primary or secondary care, are ideally placed to provide support and guidance to patients who are being discharged with benign outcomes. 28 Great strides are being taken by nurses in the safety-netting of supporting men who have been discharged without prostate cancer; however, literature surrounding the experiences of nurses caring for this patient group is lacking, and papers in this area would be very welcome to further understand how our profession is advancing the care of this cohort.…”

“…Nurses are very much in the vanguard of prostate cancer diagnosis and care with nurse‐led prostate cancer services becoming more common 4 . This means that nurses, whether they are based in primary or secondary care, are ideally placed to provide support and guidance to patients who are being discharged with benign outcomes 28…”

“…3 However, recent innovations and developments including pre-biopsy MRI have changed the landscape, allowing accurate assessment of an individual's cancer risk without the dangers of sepsis or bleeding inherent in biopsy. 4 While the provision of testing to the population at large continues to be debated, the issue of surveillance monitoring following benign investigations into raised PSA has received far less attention. With the aforementioned developments in pre-biopsy MRI, significant numbers of patients are being discharged to their GPs with a new personal PSA threshold, and a surveillance plan.…”

“…For this reason, the British Medical Journal recommends against routine PSA screening, though admits this is a weak recommendation and decisions regarding testing should be taken only in the context of open discussion between patient and GP 3 . However, recent innovations and developments including pre‐biopsy MRI have changed the landscape, allowing accurate assessment of an individual's cancer risk without the dangers of sepsis or bleeding inherent in biopsy 4 …”

Increased magnetic resonance imaging in prostate cancer management—What are the outcomes?

“…6 The best imaging procedure to locate and stage PCa tumours is bi-or multiparametric magnetic resonance imaging (b/mpMRI), 7,8 which is thought to avoid unnecessary and potentially harmful biopsies. 9 However, due to the poor accuracy of PSA, b/mpMRI yields many suspicious findings calling for further investigations. 3,[10][11][12] A prostate biopsy is necessary to establish the diagnosis.…”