Cost-effectiveness of endorectal magnetic resonance imaging for the staging of prostate cancer.

Abstract

p rostate cancer is the second most frequent cause of cancer deaths among American men. Treatment of newly diagnosed prostate cancer varies widely with stage. Patients thought to have disease confined to the prostate are Usually treated with radical prostatectomy, whereas those thought to have advanced disease are usually treated with less invasive methods, such as radiotherapy or hormonal manipulation. Thus, for most patients, the key factor in the preoperative staging of prostate cancer is the detection of disease that has spread beyond the confines of the prostate. Current methods of detecting t u m o r spread from the prostate, such as sonography and conventional magnetic resonance (MR) imaging, are limited by low resolution [1]. As many as 60% of patients undergoing radical prostatectomy for treatment of prostate cancer may have advanced disease that was not detecied preoperatively by clinical staging methods [2]. In response to the need for improved staging techniques, an endorectal surface coil for MR imaging of the prostate has been developed [3]. Because the Coil is near the prostate, a smaller fieid of view can be used, resulting in high-resolution images with improved anatomic detail. Several studies have indicated that this device may provide additional sensitivity in the detection of advanced disease without loss of specificity [4]. If previously undiscovered advanced disease can be accurately detected in patients who Otherwise would be treated surgically, endorectal MR imaging may spare these patients the risks and costs of unnecessary surgery and allow treatment with methods more appropriate to the stage of their disease. To address this issue, we have developed a cost-effectiveness model to determine the potential for endorectal blR imaging to reduce cost and improve the health of patients with prostate cancer.