Triaging patients to primary biopsy or prostate MRI based on digital rectal examination improves the detection rate of TRUS biopsy and avoids unnecessary biopsies

Abstract

Objective:

The objective of this study is to describe how the use of digital rectal exam to triage patients to standard transrectal ultrasound (TRUS) biopsies or magnetic resonance imaging (MRI) then MRI fusion biopsies impacts cancer detection rates, departmental resources and the diagnostic journey.

Patients and methods:

A retrospective analysis of all patients undergoing prostate biopsies in a 15-month period following the introduction of triage digital rectal exam (DRE) and MRI at Ayr University Hospital was conducted. MRI usage and patient journeys were also examined.

Results:

A total of 95.5% of patients proceeding directly to TRUS had malignant histology and less than 1% required further investigation. Forty-nine per cent of patients who underwent triage MRI avoided biopsy and over one-third of patients with previously benign TRUS biopsies had clinically significant malignancy on MRI fusion biopsies. The pathway eliminated repeat TRUS biopsy and the number of biopsies a month decreased. MRI usage doubled and waiting times to diagnostic biopsy increased when compared to a one-stop diagnostic clinic.

Conclusion:

Triaging according to DRE avoided delays in cases of overt malignancy and increased the detection rate of standard TRUS. For those patients with a benign DRE, MRI enabled half to avoid biopsy. The increase in demand on MRI was mitigated, in part, by using a shorter detection protocol but institutions must be aware of the potential for delays to diagnosis.

Level of evidence:

Keywords

Prostate cancer TRUS biopsy MRI fusion biopsy PIRADS score prostate MRI

Get full access to this article

View all access options for this article.

References

Schröder

Schröder Hugosson

et al . Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009; 26: 1320–1328.

Ahmed

Bosaily

Brown

et al . Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): A paired validating confirmatory study. Lancet 2017; 25: 815–822.

Barentsz

Richenberg

Clements

et al . ESUR prostate MR guidelines. Eur Radiol 2012; 22: 746–757.

Siddiqui

Rais-Bahrami

Turkbey

et al . Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA 2015; 27: 390–397.

Schoots

Roobol

Nieboer

et al . Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: A systematic review and meta-analysis. Eur Urol 2015; 68: 438–450.

Tonttila

Lantto

Pääkkö

et al . Multiparametric magnetic resonance imaging for prostate cancer diagnosis in biopsy-naive men with suspected prostate cancer based on elevated prostate-specific antigen values: Results from a randomized prospective blinded controlled trial. Eur Urol 2016; 69: 419–425.

Wegelin

Van Melick

HHE

Hooft

et al . Comparing three different techniques for magnetic resonance imaging-targeted prostate biopsies: A systematic review of in-bore versus magnetic resonance imaging-transrectal ultrasound fusion versus cognitive registration. Is there a preferred technique? Eur Urol 2017; 71: 517–531.

Oesterling

Jacobsen

Chute

et al . Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges. JAMA 1993; 18: 860–864.

Junker

Shäfer

Edlinger

et al . Evaluation of the PI-RADS scoring system for classifying mpMRI findings in men with suspicion of prostate cancer. Biomed Res Int 2013; 2013: 252939.

10.

Liddell

Rajeev

Haxhimolla

HZ.

Mp-MRI prostate characterised PIRADS 3 lesions are associated with a low risk of clinically significant prostate cancer – A retrospective review of 92 biopsied PIRADS 3 lesions. Curr Urol 2015; 8: 96–100.

11.

Moore

Kasivisnanathan

Eggener

et al . Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: Recommendations from an international working group. Eur Urol 2013; 64: 544–552.

12.

Hansen

Koo

Gallagher

et al . Comparison of initial and tertiary centre second opinion reads of multiparametric magnetic resonance imaging of the prostate prior to repeat biopsy. Eur Radiol 2017; 27: 2259–2266.

13.

Loeb

Vellekoop

Ahmed

et al . Systematic review of complications of prostate biopsy. Eur Urol 2013; 64: 876–892.

14.

Pepe

Aragona

Morbidity after transperineal prostate biopsy in 3000 patients undergoing 12 vs 18 vs more than 24 needle cores. Urology 2013; 81: 1142–1146.

15.

Radtke

Kuru

Boxler

et al . Comparative analysis of transperineal template saturation prostate biopsy versus magnetic resonance imaging targeted biopsy with magnetic resonance imaging-ultrasound fusion guidance. J Urol 2015; 193: 87–94.

16.

Information Services Division, NHS Scotland. Diagnostics report, http://www.isdscotland.org/Health-Topics/Waiting-Times/Publications/2016-05-31/2016-05-31-WT-Diagnostics-Report.pdf (2016, accessed 1 Decembe 2017).

17.

Independent Cancer Task Force. Achieving world class cancer outcomes, a strategy for England, 2015–2020, https://www.england.nhs.uk/cancer/strategy/ (2016, accessed 1 December 2017).

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.44 MB