The Introduction of 3T multiparametric magnetic resonance imaging of the prostate to a peripheral hospital – clinical utility and cost savings

Abstract

Prostate cancer (PC) is the second most common cancer in men worldwide with an estimated 1.1 million cases diagnosed in 2012. The incidence of PC varies more than 25-fold worldwide with the highest rates in Australia and New Zealand.1 In Australia it is the most commonly diagnosed cancer in men with the second highest cancer-related death.2 PC diagnosis is traditionally via systematic transrectal ultrasound-guided biopsy (TRUSGB) in men with an abnormal digital rectal examination (DRE) or elevated serum prostate-specific antigen (PSA). This method, however, has been associated with the over-diagnosis of many low-risk, clinically insignificant PCs and often failure to diagnosis clinically significant disease.3,4 The risks of prostate biopsy and treatment of PC are well established, including sepsis, incontinence and sexual dysfunction.5,6 Increasing use and improvement in 3-Tesla multiparametric magnetic resonance imaging (3T mpMRI) has provided an additional investigative modality in the workup of PC. 3T mpMRI has been shown to have high negative predictive values (NPVs) for clinically significant cancers, reducing the requirement for biopsy and increasing the detection rate.7,8 3T mpMRI is an expensive resource; however, it has been previously suggested that it may have a cost-saving benefit and role in the active surveillance management pathway.9 We aimed to assess the clinical utility and cost savings of 3T mpMRI prostate at a Queensland, Australia, hospital when compared to prostate biopsy as a first-line investigation.