Results from a PI-RADS-based MRI-directed diagnostic pathway for biopsy-naive patients in a non-university hospital

Jeroen S. Reijnen,Knut H. Hole,Irina Schönhardt,Jon B. Marthinsen,Alf O. Tysland,Christoph Müller,Erlend Andersen,Therese Seierstad

doi:10.1007/s00261-021-03249-8

Jeroen S. Reijnen, Knut H. Hole + Show 6 more

Open Access

https://doi.org/10.1007/s00261-021-03249-8

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Abstract

PurposeTo assess the safety and performance of a MRI-directed diagnostic pathway for patients with first-time suspicion of prostate cancer in a non-university hospital.MethodsBetween May 2017 and December 2018 all biopsy-naive patients examined in our hospital followed a MRI-directed diagnostic work-up algorithm based on PI-RADS score. In short, PI-RADS 1–2 was generally not biopsied and PI-RADS 3–5 was reviewed by a multidisciplinary team. Patients with PI-RADS 4-5 were all referred to biopsy, either transrectal ultrasound-guided biopsy or MRI in-bore biopsy for small tumors and for sites difficult to access. PI-RADS scores were compared to the histopathology from biopsies and surgical specimens for patients who had prostatectomy. Non-biopsied patients were referred to a safety net monitoring regimen.ResultsTwo hundred and ninety-eight men were enrolled. 97 (33%) had PI-RADS 1–2, 44 (15%) had PI-RADS 3, and 157 (53%) had PI-RADS 4–5. 116 (39%) of the patients avoided biopsy. None of these were diagnosed with significant cancer within 2–3.5 years of safety net monitoring. Almost all high ISUP grade groups (≥ 3) were in the PI-RADS 4–5 category (98%). Prostatectomy specimens and systematic biopsies from MRI-negative areas indicated that very few clinically significant cancers were missed by the MRI-directed diagnostic pathway.ConclusionOur findings add to evidence that a MRI-directed diagnostic pathway can be safely established in a non-university hospital. The pathway reduced the number of biopsies and reliably detected the site of the most aggressive cancers.Graphic abstract

Highlights

Magnetic resonance imaging (MRI) is increasingly used in the diagnostic work-up of biopsy-naive patients with suspected prostate cancer
A recent Cochrane review concluded that MRI-directed diagnostic work-up increased the detection of clinically significant prostate cancer and reduced the detection of insignificant prostate cancer compared to systematic biopsy [11]
Of the 298 patients, 97 (33%) had Prostate ImagingReporting and Data System (PI-RADS) 1–2, 44 (15%) had PI-RADS 3, and 157 (53%) had PI-RADS 4–5. 116 (39%) were not biopsied but referred to prostatespecific antigen (PSA) monitoring or follow-up with MRI

Summary

Introduction

Magnetic resonance imaging (MRI) is increasingly used in the diagnostic work-up of biopsy-naive patients with suspected prostate cancer. The ability of MRI to detect and localize clinically significant prostate cancer has been established [1,2,3,4,5,6] and MRI-directed biopsy strategies have been shown to benefit biopsy-naive patients [7,8,9,10]. A recent Cochrane review concluded that MRI-directed diagnostic work-up increased the detection of clinically significant prostate cancer and reduced the detection of insignificant prostate cancer compared to systematic biopsy [11]. On the basis of this body of evidence, the Prostate ImagingReporting and Data System (PI-RADS) committee recently proposed the PI-RADS MRI-directed biopsy pathway [12]. To achieve widespread adoption of MRI-directed diagnostic pathways without routine systematic biopsies, a large and varied body of knowledge is needed. Data from non-university hospitals are highly warranted [11, 12, 16, 19]

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