Adoption of Prebiopsy Magnetic Resonance Imaging for Men Undergoing Prostate Biopsy in the United States.

To assess adoption of prebiopsy prostate magnetic resonance imaging (MRI) in the United States and to evaluate factors associated with magnetic resonance imaging-guided prostate biopsy (MRI-Bx) use. Prior reports have shown improved cancer detection with MRI-Bx vs transrectal ultrasound-guided methods (transrectal ultrasound-guided biopsy [TRUS-Bx]). Population-based trends of their use and outcomes have not been previously characterized. Using private insurance claims (2009-2015), we identified men who underwent prostate biopsy. Exposures were biopsy year and geographic region defined by metropolitan statistical area. Outcomes included biopsy type (MRI-Bx, TRUS-Bx, or transperineal biopsy) based on procedure codes and cancer detection based on a new diagnosis for prostate cancer (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] 185). Hierarchical mixed-effects multivariable regression estimated odds of undergoing MRI-Bx. We identified 241,681 men (mean age 57.5 ± 5.4 years) who underwent biopsy. The use of MRI-Bx rose rapidly (0.2% in 2009 to 6.5% in 2015, P <.001). Overall, 3429 men underwent MRI before biopsy, more commonly in metropolitan statistical areas (odds ratio 1.90, 95% confidence interval 1.66-2.19). In 2015, nearly 18% of men with prior negative biopsy underwent a prebiopsy MRI. Patients with prior negative biopsies were over 4 times more likely to use MRI guidance (vs no prior biopsies, odds ratio 4.63, 95% confidence interval 4.27-5.02) and had a greater chance of cancer detection with MRI-Bx (25.2%) vs TRUS-Bx (19.7%, P = .010). Among men undergoing prostate biopsy, prebiopsy prostate MRI utilization was concentrated within urban areas and among patients with prior negative biopsies, where its use was associated with superior cancer detection compared with traditional TRUS-Bx.

Liu W ，Patil D ，Howard DH ，Moore RH ，Wang H ，Sanda MG ，Filson CP ... -  《-》

Impact of prebiopsy magnetic resonance imaging of the prostate on cancer detection and treatment patterns.

Though superior in clinical trial settings, outcomes following magnetic resonance image (MRI)-guided prostate biopsies have not been reported broadly. We compared prostate cancer detection rates for men who did and did not undergo prebiopsy MRI and evaluated treatment patterns based on biopsy approach, year of biopsy, and proximity to early adopters. Using private insurance claims (2009-2015), we identified men who underwent prostate biopsy using appropriate procedure codes. Exposure was receipt of prebiopsy MRI within 3 months prior to biopsy. Outcomes included new prostate cancer diagnosis, treatment with prostatectomy/radiation, and receipt of adjunct procedures typically used for higher-risk disease (i.e., lymphadenectomy with prostatectomy, androgen deprivation therapy with radiation). Hierarchical mixed-effects multivariable logistic regression predicted probabilities of each outcome. We identified 77,350 men (mean age 57.5 ± 5.4 years) who underwent biopsy with 12% having had a prior negative biopsy. Use of prebiopsy MRI was more common among men biopsied from 2014 to 2015 (4.4% vs. 1.3% 2012-2013), in metropolitan statistical areas (2.6% vs. 1.1% not), residing close to early adopters (5.5% vs. 1.5% far), and with prior negative biopsy (7.3% vs. 1.7% biopsy-naïve; all P < 0.001). Compared to patients with a prior negative biopsy and no MRI, men were more likely to be diagnosed with prostate cancer if they had a prior negative biopsy and MRI (24.7% vs. 21.4% prior negative without MRI, odds ratio 1.25, 95% confidence interval 1.04-1.51) or an initial biopsy without prior MRI (40.0% vs. 21.4% prior negative without MRI, odds ratio 2.49, 95% confidence interval 2.36-2.64; P < 0.001). Predicted probability of treatment overall and adjunct treatment did not differ based on receipt of pre-biopsy MRI. Among privately insured men in the United States, use of prostate MRI prior to prostate biopsy was associated with increased cancer detection among those with prior negative biopsies, but we did not observe significant changes with downstream treatment patterns.

Liu W ，Patil D ，Howard DH ，Moore RH ，Wang H ，Sanda MG ，Filson CP ... -  《-》

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.

Multiparametric magnetic resonance imaging (MRI) of the prostate may improve the diagnostic accuracy of prostate cancer detection in MRI-targeted biopsy (MRI-TBx) in comparison to transrectal ultrasound-guided biopsy (TRUS-Bx). Systematic review and meta-analysis of evidence regarding the diagnostic benefits of MRI-TBx versus TRUS-Bx in detection of overall prostate cancer (primary objective) and significant/insignificant prostate cancer (secondary objective). A systematic review of Embase, Medline, Web of Science, Scopus, PubMed, Cinahl, and the Cochrane library was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Identified reports were critically appraised according to the Quality Assessment of Diagnostic Accuracy Studies criteria. Only men with a positive MRI were included. The reports we included (16 studies) used both MRI-TBx and TRUS-Bx for prostate cancer detection. A cumulative total of 1926 men with positive MRI were included, with prostate cancer prevalence of 59%. MRI-TBx and TRUS-Bx did not significantly differ in overall prostate cancer detection (sensitivity 0.85, 95% confidence interval [CI] 0.80-0.89, and 0.81, 95% CI 0.70-0.88, respectively). MRI-TBx had a higher rate of detection of significant prostate cancer compared to TRUS-Bx (sensitivity 0.91, 95% CI 0.87-0.94 vs 0.76, 95% CI 0.64-0.84) and a lower rate of detection of insignificant prostate cancer (sensitivity 0.44, 95% CI 0.26-0.64 vs 0.83, 95% confidence interval 0.77-0.87). Subgroup analysis revealed an improvement in significant prostate cancer detection by MRI-TBx in men with previous negative biopsy, rather than in men with initial biopsy (relative sensitivity 1.54, 95% CI 1.05-2.57 vs 1.10, 95% CI 1.00-1.22). Because of underlying methodological flaws of MRI-TBx, the comparison of MRI-TBx and TRUS-Bx needs to be regarded with caution. In men with clinical suspicion of prostate cancer and a subsequent positive MRI, MRI-TBx and TRUS-Bx did not differ in overall prostate cancer detection. However, MRI-TBx had a higher rate of detection of significant prostate cancer and a lower rate of detection of insignificant prostate cancer compared with TRUS-Bx. We reviewed recent advances in magnetic resonance imaging (MRI) for guidance and targeting of prostate biopsy for prostate cancer detection. We found evidence to suggest that MRI-guided targeted biopsy benefits the diagnosis of prostate cancer.

Schoots IG ，Roobol MJ ，Nieboer D ，Bangma CH ，Steyerberg EW ，Hunink MG ... -  《-》

Multiparametric MRI in detection and staging of prostate cancer.

Boesen L 《Danish Medical Journal》

Early experience with multiparametric magnetic resonance imaging-targeted biopsies under visual transrectal ultrasound guidance in patients suspicious for prostate cancer undergoing repeated biopsy.

Boesen L ，Noergaard N ，Chabanova E ，Logager V ，Balslev I ，Mikines K ，Thomsen HS ... -  《-》