The utility of magnetic resonance imaging in prostate cancer diagnosis in the Australian setting

Abstract

Objectives To investigate the utility of Magnetic Resonance Imaging (MRI) for prostate cancer diagnosis in the Australian setting. Patients and methods All consecutive men who underwent a prostate biopsy (transperineal or transrectal) at Royal Melbourne Hospital between July 2017 to June 2019 were included, totalling 332 patients. Data were retrospectively collected from patient records. For each individual patient, the risk of prostate cancer diagnosis at biopsy based on clinical findings was determined using the European Randomized study of Screening for Prostate Cancer (ERSPC) risk calculator, with and without incorporation of MRI findings. Results MRI has good diagnostic accuracy for clinically significant prostate cancer. A PI‐RADS 2 or lower finding has a negative predictive value of 96% for clinically significant cancer, and a PI‐RADS 3, 4 or 5 MRI scan has a sensitivity of 93%. However, MRI has a false negative rate of 6.5% overall for clinically significant prostate cancers. Pre‐ biopsy MRI may reduce the number of unnecessary biopsies, as up to 50.0% of negative or ISUP1 biopsies have MRI PI‐RADS 2 or lower. Incorporation of MRI findings into the ERSPC calculator improved predictive performance for all prostate cancer diagnoses (AUC 0.77 vs 0.71, P = .04), but not for clinically significant cancer (AUC 0.89 vs 0.87, P = .37). Conclusion MRI has good sensitivity and negative predictive value for clinically significant prostate cancers. It is useful as a pre‐biopsy tool and can be used to significantly reduce the number of unnecessary prostate biopsies. However, MRI does not significantly improve risk predictions for clinically significant cancers when incorporated into the ERSPC risk calculator.

Sensible government decisions on funding for imaging can change practice and deliver better care for men with prostate cancer

“…What have we learned from mpMRI and what have we gained? We have learnt it is pretty good but not perfect [3]. Yet we have also gained a buffer against the two greater evils of prostate cancer – overdiagnosis and overtreatment.…”

BJUI Compass 2021 year‐end review

“…For example, African American race was a predictor of GG2‐5 prostate cancer, but did not modify the effect of PHI, PSA density, or PiRADS scores. Furthering our progress in prostate cancer diagnostics, Tay et al 3 performed a deep dive into prostate MRI metrics at an Australian referral center. They found a negative predictive value of 96% at PiRADS 2 or lower.…”

“…Furthering our progress in prostate cancer diagnostics, Tay et al 3 performed a deep dive into prostate MRI metrics at an Australian referral center. They found a negative predictive value of 96% at PiRADS 2 or lower.…”