T Barrett1, R Slough2, N Sushentsev3, N Shaida2, B C Koo2, I Caglic4, V Kozlov5, A Y Warren6, V Thankappannair7, C Pinnock8, N Shah7, K Saeb-Parsy7, V J Gnanapragasam7, E Sala2, C Kastner7. 1. CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK. Electronic address: tristan.barrett@addenbrookes.nhs.uk. 2. CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK. 3. Sechenov Biomedical Science & Technology Park, Sechenov First Moscow State Medical University, Moscow, Russia. 4. Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK. 5. Department of Public Health and Healthcare Organisation, Sechenov First Moscow State Medical University, Moscow, Russia. 6. CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Pathology, Addenbrooke's Hospital, Cambridge, UK. 7. CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK. 8. CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Clinical Excellence Research Centre, Stanford University School of Medicine, California, USA.
Abstract
AIM: To evaluate the effect of pre-biopsy magnetic resonance imaging (MRI) on cancer diagnostic times, and to report MRI-directed pathology outcomes. MATERIALS AND METHODS: In total, 1483 patients were referred with prostate cancer suspicion during a 30-month period. Upfront MRI was performed in 745 patients: 332 MRIs in the 15 months prior to dedicated scanning slots (group 1), and 413 in the 15 months post-introduction (group 2). A further 88 patients had initial MRI following clinical assessment. Biopsy via the transrectal (TR) or transperineal (TP) approach was performed, with MRI/ultrasound fusion for MRI targets. Clinically significant cancer (csPCa) was defined as Gleason ≥3+4. Negative MRIs were defined as Likert 1-2. Per-case clinical decisions were taken to biopsy or not. RESULTS: 44.4% of patients avoided biopsy. 484/833 (58.1%) MRIs were negative; 37.4% of these patients had biopsy with a negative predictive value (NPV) of 92.8% for Gleason ≥3+4 and 98.3% for ≥4+3. Overall prostate cancer prevalence was 34.3% (24.6% csPCa). In 323 MRI-positive cases, any cancer was present in 78.9% (csPCa 60.4%). Of the 1483 patients, 1232 (83.1%) completed all diagnostic tests within 28 days. Upfront MRI patients met this standard in 621/833 (74.5%), improving from 66.9% to 81.1% with reserved slots (group 2) with a reduced diagnostic time from median 25.5 to 20.9 days. Biopsy scheduling delayed the pathway in 69.7%, with MRI responsible in 22.3%, reducing to 10.3% in group 2. TP biopsies met the 28-day standard in significantly less cases (29.7%), compared to TR (67.4%, p<0.0001). CONCLUSION: Reserved MRI slots reduces time-to-diagnosis, and upfront MRI safely avoids biopsy in a significant proportion of men, whilst maintaining expected csPCa detection rates.
AIM: To evaluate the effect of pre-biopsy magnetic resonance imaging (MRI) on cancer diagnostic times, and to report MRI-directed pathology outcomes. MATERIALS AND METHODS: In total, 1483 patients were referred with prostate cancer suspicion during a 30-month period. Upfront MRI was performed in 745 patients: 332 MRIs in the 15 months prior to dedicated scanning slots (group 1), and 413 in the 15 months post-introduction (group 2). A further 88 patients had initial MRI following clinical assessment. Biopsy via the transrectal (TR) or transperineal (TP) approach was performed, with MRI/ultrasound fusion for MRI targets. Clinically significant cancer (csPCa) was defined as Gleason ≥3+4. Negative MRIs were defined as Likert 1-2. Per-case clinical decisions were taken to biopsy or not. RESULTS: 44.4% of patients avoided biopsy. 484/833 (58.1%) MRIs were negative; 37.4% of these patients had biopsy with a negative predictive value (NPV) of 92.8% for Gleason ≥3+4 and 98.3% for ≥4+3. Overall prostate cancer prevalence was 34.3% (24.6% csPCa). In 323 MRI-positive cases, any cancer was present in 78.9% (csPCa 60.4%). Of the 1483 patients, 1232 (83.1%) completed all diagnostic tests within 28 days. Upfront MRI patients met this standard in 621/833 (74.5%), improving from 66.9% to 81.1% with reserved slots (group 2) with a reduced diagnostic time from median 25.5 to 20.9 days. Biopsy scheduling delayed the pathway in 69.7%, with MRI responsible in 22.3%, reducing to 10.3% in group 2. TP biopsies met the 28-day standard in significantly less cases (29.7%), compared to TR (67.4%, p<0.0001). CONCLUSION: Reserved MRI slots reduces time-to-diagnosis, and upfront MRI safely avoids biopsy in a significant proportion of men, whilst maintaining expected csPCa detection rates.
Authors: Tristan Barrett; Ferdia A Gallagher; Nikita Sushentsev; Mary A McLean; Anne Y Warren; Arnold J V Benjamin; Cara Brodie; Amy Frary; Andrew B Gill; Julia Jones; Joshua D Kaggie; Benjamin W Lamb; Matthew J Locke; Jodi L Miller; Ian G Mills; Andrew N Priest; Fraser J L Robb; Nimish Shah; Rolf F Schulte; Martin J Graves; Vincent J Gnanapragasam; Kevin M Brindle Journal: Nat Commun Date: 2022-01-24 Impact factor: 14.919
Authors: Tristan Barrett; Simon Pacey; Kelly Leonard; Jerome Wulff; Ionut-Gabriel Funingana; Vincent Gnanapragasam Journal: Eur Urol Open Sci Date: 2022-02-10
Authors: Bas Israël; Jos Immerzeel; Marloes van der Leest; Gerjon Hannink; Patrik Zámecnik; Joyce Bomers; Ivo G Schoots; Jean-Paul van Basten; Frans Debruyne; Inge van Oort; Michiel Sedelaar; Jelle Barentsz Journal: BJU Int Date: 2021-08-23 Impact factor: 5.969