Mp26-15 head-to-Head Comparison of Prostate Cancer Detection Rate at Multiparametric Magnetic Resonance Imaging-Targeted Fusion Biopsy Between Hub and Spoke Centers

Abstract

INTRODUCTION AND OBJECTIVE: European guidelines on prostate cancer strongly recommend multiparametric magnetic resonance imaging (mpMRI) before prostate biopsy in patients with clinical suspicion of prostate cancer (PCa). This led to the diffusion of mpMRI even in small non-academic centers. This could have an impact on mpMRI-targeted biopsy (TB) detection rate, given by possible "false positive targets". We aimed to evaluate the PCa detection rate on TB according to the mpMRI canter's volume and experience.METHODS: We retrospectively analyzed data of 737 patients who underwent mpMRI-TB at our clinic for suspicion of PCa, using Toshiba Aplio 500ä mpMRI-TRUS Fusion platform. Transrectal approach was chosen for TB, taking 3 biopsy cores targeted to the index lesion. TB were performed by 4 expert urologists. Specimens were processed by dedicated pathologists. Patients were stratified according to the center in which mpMRI is performed: high volume mpMRI academic (Hub; >300 mpMRI per year) vs. low volume mpMRI non-academic (Spoke; <300 mpMRI per year) centers. In each center, all lesions were scored using the PI-RADS-v2. Differences in detection rate for any PCa and for clinically significant PCa (csPCa) between the two groups were explored. We evaluated predictors of csPCa on TB with multivariable logistic regression. The adjustment for casemix included: age, PSA, mpMRI center (Hub vs. Spoke), lesion's location, PSA density, PI-RADS-v2 score and index lesion's size.RESULTS: Overall, 449 (60.9%) and 288 (39.1%) patients underwent mpMRI at a Hub or Spoke center, respectively. Significantly lower rate of PIRADS 3 lesions were reported in Spoke group compared to Hub group (36.1% vs 49%; p<0.001). Patients in the Hub group had higher detection rate for any PCa (60.3% vs 48.1%) and csPCa (46.9% vs 38.7%; all p 0.001). After stratifying for PI-RADS-v2 score, patients in Hub group had higher detection rate for PI-RADS-v2 score 3 (any PCa 43.6% vs. 28.2% and csPCA 25.2% vs. 15.7%; all p 0.04) and PI-RADS-v2 score 4 (any PCa 74.7% vs. 55% and csPCa 65.7% vs. 45.7%; all p 0.001) compared to patients in Spoke group. At multivariable analyses patients with mpMRI performed in a Spoke center was found to be an independent predictor for detection of csPCa at TB (OR 0.65; p[0.04).CONCLUSIONS: Our study shows that mpMRI performed in Hub centers provided a significantly higher PCa yield on TB. Dedicated radiologist for mpMRI is essential to avoid unnecessary and potentially harmful procedures.