Introduction of MRI/Ultrasound (MRI/US) fusion prostate biopsy over the last decade has allowed for the improved diagnosis of high-risk prostate cancer and fewer low-risk cases of prostate cancer in comparison to standard sextant biopsy.1 Furthermore, beyond better diagnosis and risk-stratification, this technology may be improving treatment by allowing urologists to track lesions over time through active surveillance. Targeted MRI/US biopsy is an emerging technology, and while it is believed that its implementation has expanded in recent years, quantitative analysis to describe these trends was not available.
In this study, we developed a 20-question survey distributed to urologists across the United States to assess the ways in which urologists employ MRI in their prostate cancer practices as well as assess attitudes regarding the role of MRI/US guided biopsy.2 The questionnaire gathered information regarding demographics, current and recent changes in MRI use, opinions on targeted MRI/US guided biopsy, and barriers to implementation. We analyzed the results of the survey to assess the variability of opinions and use between demographic groups.
Overall, 86% of respondents currently employ prostate MRI in some capacity in their practice. We first looked at practice setting, which proved to be a significant factor in MRI use with academic centers reporting the greatest utilization of targeted biopsy and solo practitioners the least. We then analyzed by geographic region (Figure 1), and found the northeast demonstrated greater use of MRI (92%) relative to other regions in the United States.
Figure 1: Monthly Prostate MRIs Performed. Participant responses regarding monthly MRIs performed or ordered in their practice. Graphical display (a) and summary table (b) with an absolute number of respondents and percentages displayed respectively.
In addition, we also asked participants how the use of MRI in their practice has changed over the past 5 years (Figure 2), which showed an overall upward trend in MRI use.
Figure 2: Changes in MRI Use. Participants were asked how their use of MRI imaging in their practice has changed in the past 5 years with regards to MRI/US guided biopsy, AS, and pre-prostatectomy imaging.
MRI use depends on resources and overcoming barriers, and sixty percent of respondents reported working for an institution or group with the resources to perform MRI/US guided biopsies, with the highest percentage going to urologists at academic centers and the smallest going to those in solo private practice. Urologists who did not possess the resources necessary to perform MRI/US targeted biopsies were then asked to list the specific barriers to the implementation of this technology. A majority of respondents cited cost as a barrier to implementation, followed by insurance coverage issues, and lack of necessary infrastructure and/or trained personnel.
All in all, regional and practice setting variations exist in the adaptation of the MRI/US fusion technology. While there are some reservations about employing MRI/US guided biopsy for all men with suspicion of prostate cancer, the data suggest urologists support its use and are making efforts to introduce targeted MRI/US guided biopsy into their practice.
1. M. Minhaj Siddiqui, Arvin K. George, Rachel Rubin, Soroush Rais-Bahrami, Howard L. Parnes, Maria J. Merino, Richard M. Simon, Baris Turkbey, Peter L. Choyke, Bradford J. Wood, Peter A. Pinto, Efficiency of Prostate Cancer Diagnosis by MR/Ultrasound Fusion-Guided Biopsy vs Standard Extended-Sextant Biopsy for MR-Visible Lesions, JNCI: Journal of the National Cancer Institute, Volume 108, Issue 9, September 2016, https://doi.org/10.1093/jnci/djw039
2. Tooker G, M, Truong H, Pinto P, A, Siddiqui M,: National Survey of Patterns Employing Targeted MRI/US Guided Prostate Biopsy in the Diagnosis and Staging of Prostate Cancer. Curr Urol 2018;12:97-103. https://doi.org/10.1159/000489426
Written by: Erin Hays, and Mohummad M. Siddiqui, MD, University of Maryland School of Medicine