Current beliefs and practice patterns among urologists regarding prostate magnetic resonance imaging and magnetic resonance–targeted biopsy

Abstract

Introduction and Objective Multiparametric MRI (mpMRI) and MR targeted biopsy have a growing role in the screening and evaluation of prostate cancer. We aim to evaluate the current knowledge, attitude, and practice patterns of urologists regarding this new technique. Methods An anonymous online questionnaire was designed to collect information on urologists’ beliefs and use of prostate mpMRI and MR targeted biopsy. The survey was sent to members of the Society of Urologic Oncology (SUO), the Endourological Society (ES), and European Association of Urology (EAU). Multivariate logistic regression analysis was performed to determine predictors for use of prostate MRI and MR targeted biopsy. Results A total of 302 responses were received [ES: 175, EAU: 23, SUO: 104]. The majority of respondents (83.6%) believe MR targeted biopsy to be moderately to extremely beneficial in the evaluation of prostate cancer. 85.7% of responders utilize prostate MR imaging in their practice, and 63.0% utilize MR targeted biopsy. The two most common settings for utilization of MR targeted biopsy include patients with history of prior negative biopsy (96.3%) and monitoring patients on active surveillance (72.5%). In those who do not utilize MR targeted biopsy, the principal reasons were lack of necessary infrastructure (64.1%) and prohibitive costs (48.1%). On multivariate logistic regression analysis, practice in an academic setting (1.86 [1.02–3.40], p = 0.043), and performing > 25 radical prostatectomies per year (2.32 [1.18–4.56], p = 0.015) remained independent predictors for utilizing MR targeted biopsy. Conclusions A majority of respondents to our survey look favorably upon use of prostate MRI and MR targeted biopsy in clinical practice. Over time, reduction in fixed costs and easier access to equipment may lead to further dissemination of this novel and potentially transformative technology.

MRI in active surveillance: a critical review

“…Many urologists believe that mpMRI could be a useful tool for assessing risk in biopsy-naïve patients and monitoring AS cohorts, but cost and lack of appropriate infrastructure are considered significant obstacles preventing the implementation of imaging-based patient pathways (60). Cost-effectiveness analysis suggests that an MRIguided prostate cancer diagnostic pathway would result in fewer men needing biopsies and greater detection of clinically significant disease, in the prostate cancer detection setting (61).…”

Current Role of Multiparametric MRI and MRI Targeted Biopsies for Prostate Cancer Diagnosis in Germany: A Nationwide Survey

“…Not surprisingly, mpMRI was proved to be a valuable, widely used tool as 95.9% of the participants use mpMRI of the prostate at some point and 83.2% also recommend MRtb. There have been only few surveys, predominantly in the US, indicating a similarly high number of urologists to utilize prostate mpMRI imaging in their daily practice (85.7–86%) but a lower number of urologists considering MRtb (60–63%) [8, 9]. Our study might report a higher acceptance for and application of MRtb since this technique needs some sophisticated equipment and infrastructure and therefore its broader application takes time.…”

Multi‐institutional nomogram predicting benign prostate pathology on magnetic resonance/ultrasound fusion biopsy in men with a prior negative 12‐core systematic biopsy

“…A nomogram was developed with 285 consecutive patients with at least 1 prior negative biopsy session who underwent FB for abnormal mpMRI findings (ie, a PI-RADS score of [3][4][5] at the University of Rochester Medical Center (URMC) from December 2014 to December 2016, or at the University of Alabama at Birmingham (UAB) from February 2014 to February 2017. A nomogram was developed with 285 consecutive patients with at least 1 prior negative biopsy session who underwent FB for abnormal mpMRI findings (ie, a PI-RADS score of [3][4][5] at the University of Rochester Medical Center (URMC) from December 2014 to December 2016, or at the University of Alabama at Birmingham (UAB) from February 2014 to February 2017.…”

“…1,2 FB technology is rapidly being adopted at many centers. 3,4 According to a consensus statement by the American Urological Association and the Society of Abdominal Radiology, the use of mpMRI after a prior negative biopsy is supported by the current literature, and patients with a Prostate Imaging Reporting and Data System (PI-RADS) suspicion score of 3 to 5 warrant a biopsy. 5 The detection rate for PCa with a GS 3 1 4 is highly dependent on the PI-RADS score.…”