Peter Donato1,2, Andrew Morton1,2, John Yaxley1,2,3, Patrick E Teloken1,2, Geoff Coughlin1,3, Rachel Esler1,3, Nigel Dunglison1,3, Robert A Gardiner1,2,4,5, Matthew J Roberts6,7,8. 1. Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia. 2. Faculty of Medicine, The University of Queensland, Herston, QLD, 4029, Australia. 3. Wesley Urology Clinic, Brisbane, Australia. 4. Griffith University, Queensland, Australia. 5. Edith Cowan University, Joondalup, WA, Australia. 6. Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia. m.roberts2@uq.edu.au. 7. Faculty of Medicine, The University of Queensland, Herston, QLD, 4029, Australia. m.roberts2@uq.edu.au. 8. Nepean Urology Research Group, Kingswood, NSW, Australia. m.roberts2@uq.edu.au.
Abstract
PURPOSE: Multiparametric magnetic resonance imaging (mpMRI) improves clinically significant prostate cancer (csPCa) detection by facilitating targeted biopsy (cognitive, fusion technology, or in-gantry MRI guidance) and reducing negative biopsies. This study sought to describe the feasibility of introducing an mpMRI-based triage pathway, including diagnostic performance, applicability to training, and cost analysis. METHODS: An observational retrospective cohort study of consecutive patients attending a large public tertiary referral training hospital who underwent mpMRI for suspicion of prostate cancer was considered. Standard clinical, MRI-related, histopathological, and financial parameters were collected for analysis of biopsy avoidance, diagnostic accuracy of biopsy approach, and operator (consultant and resident/registrar) and logistical (including financial) feasibility. RESULTS: 653 men underwent mpMRI, of which 344 underwent prostate biopsy resulting in a 47% biopsy avoidance rate. Overall, 240 (69.8%) patients were diagnosed with PCa, of which 208 (60.5%) were clinically significant, with higher rates of csPCa observed for higher PIRADS scores. In patients who underwent both systematic and targeted biopsy (stTPB), targeted cores detected csPCa in 12.7% and 16.6% in more men than systematic cores in PIRADS 5 and 4, respectively, whereas systematic cores detected csPCa in 5% and 3.2% of patients, where targeted cores did not. A high standard of performance was maintained across the study period and the approach was shown to be cost effective. CONCLUSIONS: Introdution of an mpMRI-based triage system into a large public tertiary teaching hospital is feasible, cost effective and leads to high rates of prostate cancer diagnosis while reducing unnecessary biopsies and detection of insignificant PCa.
PURPOSE: Multiparametric magnetic resonance imaging (mpMRI) improves clinically significant prostate cancer (csPCa) detection by facilitating targeted biopsy (cognitive, fusion technology, or in-gantry MRI guidance) and reducing negative biopsies. This study sought to describe the feasibility of introducing an mpMRI-based triage pathway, including diagnostic performance, applicability to training, and cost analysis. METHODS: An observational retrospective cohort study of consecutive patients attending a large public tertiary referral training hospital who underwent mpMRI for suspicion of prostate cancer was considered. Standard clinical, MRI-related, histopathological, and financial parameters were collected for analysis of biopsy avoidance, diagnostic accuracy of biopsy approach, and operator (consultant and resident/registrar) and logistical (including financial) feasibility. RESULTS: 653 men underwent mpMRI, of which 344 underwent prostate biopsy resulting in a 47% biopsy avoidance rate. Overall, 240 (69.8%) patients were diagnosed with PCa, of which 208 (60.5%) were clinically significant, with higher rates of csPCa observed for higher PIRADS scores. In patients who underwent both systematic and targeted biopsy (stTPB), targeted cores detected csPCa in 12.7% and 16.6% in more men than systematic cores in PIRADS 5 and 4, respectively, whereas systematic cores detected csPCa in 5% and 3.2% of patients, where targeted cores did not. A high standard of performance was maintained across the study period and the approach was shown to be cost effective. CONCLUSIONS: Introdution of an mpMRI-based triage system into a large public tertiary teaching hospital is feasible, cost effective and leads to high rates of prostate cancer diagnosis while reducing unnecessary biopsies and detection of insignificant PCa.
Entities:
Keywords:
Cognitive-fusion prostate biopsy; Multiparametric MRI; Prostate cancer; Prostate imaging reporting and data system; Systematic prostate biopsy; Transperineal prostate biopsy
Authors: Matthew J Roberts; Alastair Macdonald; Sachinka Ranasinghe; Harrison Bennett; Patrick E Teloken; Patrick Harris; David Paterson; Geoff Coughlin; Nigel Dunglison; Rachel Esler; Robert A Gardiner; Thomas Elliott; Louisa Gordon; John Yaxley Journal: Prostate Cancer Prostatic Dis Date: 2020-08-05 Impact factor: 5.554
Authors: Akshay Wadera; Mostafa Alabousi; Alex Pozdnyakov; Mohammed Kashif Al-Ghita; Ali Jafri; Matthew Df McInnes; Nicola Schieda; Christian B van der Pol; Jean-Paul Salameh; Lucy Samoilov; Kaela Gusenbauer; Abdullah Alabousi Journal: Br J Radiol Date: 2020-10-22 Impact factor: 3.039
Authors: Visalini Nair-Shalliker; David P Smith; Val Gebski; Manish I Patel; Mark Frydenberg; John W Yaxley; Robert Gardiner; David Espinoza; Michael G Kimlin; Michael Fenech; David Gillatt; Henry Woo; Bruce K Armstrong; Krishan Rasiah; Nader Awad; James Symons; Howard Gurney Journal: BMJ Open Date: 2021-03-02 Impact factor: 2.692
Authors: William John Yaxley; François-Xavier Nouhaud; Sheliyan Raveenthiran; Anthony Franklin; Peter Donato; Geoff Coughlin; Boon Kua; Troy Gianduzzo; David Wong; Robert Parkinson; Nicholas Brown; Hemamali Samaratunga; Brett Delahunt; Lars Egevad; Matthew Roberts; John William Yaxley Journal: Prostate Cancer Prostatic Dis Date: 2020-09-30 Impact factor: 5.554