What do urologists think about using MRI in prostate cancer diagnosis and management today?

Staff at the Urologic Oncology Branch of the National Cancer Institute have just published the results of a survey evaluating current knowledge of (some) specialist urologists and urologic oncologists about the roles of MRI scanning in the diagnosis of prostate cancer and how they are integrating the use of MRI scanning and MR-guided biopsies into their clinical practice. The full text of this article by Muthigi et al. is available on line.

The authors created a 22-question on-line survey that was promoted to members of the Endourology Society and to some members of the European Association for Urology. A slightly shorter 16-question on-line survey was promoted to members of the Society of Urologic Oncology. (The 16-question survey did not eliminate any key questions about the use of MRI scanning in the management of prostate cancer.) Unfortunately, the survey does not seem to have been sent to all members of the American Urology Association.

It was not possible to tell exactly how many physicians received the request to complete the survey. What we do know is that it was completed by a total of 302 physicians (which is a reasonable representative sample). And the results seem to be reasonably positive (from a patient perspective):

  • Of the 302 respondents
    • 143 (48.2 percent) had trained in urologic oncology
    • 208 (68.9 percent) were practicing in an academic setting
  • 83.6 percent of respondents “believe MR-targeted biopsy to be moderately to extremely beneficial in the evaluation of prostate cancer.”
  • 85.7 percent of respondents use prostate MRI in their practice, and 63.0 percent use MR-targeted biopsy.
  • 65.7 percent of respondents thought that MR-targeted biopsy is more accurate than systematic biopsy in the detection of clinically significant prostate cancer.
  • The two most common  uses of MR-targeted biopsy are
    • In the re-biopsy of patients with history of prior negative biopsy result (96.3 percent)
    • In monitoring patients on active surveillance (72.5 percent)
  • Independent predictors for the use of MR-guided biopsy included
    • Practicing in an academic setting
    • Performing 26 or more radical prostatectomies per year

However, among 106 physicians who are not yet using MR-targeted biopsy, the principal reasons for lack of such use seem to be

  • Lack of necessary infrastructure (64.2 percent)
  • Prohibitive costs (48.1 percent)

The authors concluded that

Most respondents of our survey look favorably on use of prostate MRI and MR-targeted biopsy in clinical practice. Over time, reduction in fixed costs and easier access to equipment may lead to further dissemination of this novel and potentially transformative technology.

As one might have expected, the use and acceptance and availability of MRIs and MR-guided or MR/TRUS fusion-guided biopsies seems to be more widespread at academic urology centers than it is out in the community to date. Hopefully, access to this form of technology will become more widespread in community practice settings over the next 5 years.

2 Responses

  1. Any comments about the controversy on the use of gadolinium contrast agents used for MRIs?

  2. No. This was not addressed in the questionnaire (as far as I can tell).

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