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

Abstract

Introduction: Multiparametric MRI (mpMRI) and MRI targeted biopsies (MRtb) are a new standard in prostate cancer (PCa) screening and diagnosis. Guidelines already include this approach for patients at risk. We aimed to gather information from German urologists about their knowledge, routine use, and attitude toward mpMRI and consecutive biopsy methods. Materials and Methods: An anonymous online questionnaire was sent via Survey Monkey to the members of the German Society of Urology (DGU). Statistical analyses were performed using SPSS version 25.0. Results: 496 members with a median age of 48.6 years (±11.7) participated in the survey. The majority rated mpMRI of the prostate as a very useful diagnostic tool (72.7%). MRtb of the prostate was considered as very advantageous (71.5%). MpMRI was used by 95.9%, and 83.2% also recommended MRtb predominantly in clinical institutions. For targeted biopsy, MRI-ultrasound fusion biopsy was clearly favored (75.8%). MpMRI was mostly used in patients with previously negative biopsy (90.9%) and in patients under active surveillance (60.9%). Arguments against the use of prostate mpMRI are costs (84.9%) and/or lack of sufficient radiological infrastructure (17.4%). Conclusion: Our data illustrate the meanwhile high acceptance and clinical use of the prostate mpMRI and MRtb in Germany.

Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study

“…Recently, several diagnostic procedures, such as multiparametric magnetic resonance imaging (mpMRI) or prostate health index, have become available to increase the prediction of IPC [20, 21]. On the other hand, it has so far been difficult to anticipate the occurrence of IPC after surgical treatment of BPO.…”

Correlation of MRI-Lesion Targeted Biopsy vs. Systematic Biopsy Gleason Score with Final Pathological Gleason Score after Radical Prostatectomy

“…Goel et al found that upgrading rates are significantly higher in SB Gleason patterns, while concordance is significantly more frequent in TB Gleason patterns. These observations are particularly important since MRI-targeted biopsies are increasing within recent years due to improving quality, as well as easy and quick performance [ 28 , 29 , 30 , 31 ]. In consequence, whenever TB is performed and separate biopsy GS are available for TB and SB, clinical decision-making and patient counseling should rather be based on the findings of TB GS than on SB GS for predicting final pathology.…”

Serum miRNAs Support the Indication for MRI-Ultrasound Fusion-Guided Biopsy of the Prostate in Patients with Low-PI-RADS Lesions

“…A recent nationwide survey among clinicians in Germany underscores the widespread acceptance of mpMRI and targeted prostatic biopsies [5]. Despite the gain in diagnostic accuracy by mpMRI, there is still an on-going effort to utilize this information for risk classification.…”

“…Our study shows that it is possible to enhance the prediction of PCa detection by adding serum miRNA expression levels to clinical data and the PI-RADS score. However, up to now, there is a strong suggestion that PI-RADS 3 lesions should also be biopsied [5,23], because they might harbor significant PCa ranging from 12% [24] to 34% in current cohorts [25], even though other studies show only a limited incidence of significant PCa [26]. Yang et al utilized mpMRI imaging information and routine clinical parameters for modeling cancer risk particularly in patients with PI-RADS 3 lesions and suggested their model for the reduction of unnecessary biopsies [27].…”

“…Multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy of tumorsuspicious lesions have become established diagnostic tools for the detection of prostate cancer (PCa) [1], since ultrasound-guided biopsy alone misses approximately 25-30% of PCa cases [2,3]. MpMRI has demonstrated a higher sensitivity and specificity for the detection of PCa [4] and is widely accepted among healthcare practitioners [5].…”