A survey of Canadian urologists' and radiologists' perspectives regarding the use of prostate magnetic resonance imaging in biopsy-naive patients
Douglas Cheung1, Alexis Lund1, Lisa J. Martin1, Maria Komisarenko1, Nathan Perlis1, Masoom Haider2, Antonio Finelli1.
1Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; 2Department of Medical Imaging, Mount Sinai Hospital, Toronto, ON, Canada
This work was supported by Prostate Cancer Canada/Canadian Cancer Society (Grant #707044)..
Introduction: Evidence and guidelines now support the use of magnetic resonance imaging (MRI) in biopsy-naive men to improve detection of clinically significant prostate cancer (PCa), decrease overdiagnosis of insignificant PCa, and avoid biopsy in low-risk cases. However, the demand for MRI will be difficult to meet within the Canadian universal healthcare system.
Methods: Separate surveys were developed for urologists and radiologists in Canada to assess perspectives on the use of pre-biopsy MRI, barriers to implementation, and to explore options for streamlining high- and low-risk patients. After iterative development, bilingual surveys were distributed from June to September 2021.
Results: Respondents included 175 urologists and 84 radiologists (Table 1); 61% of urologists expected an increase of >50% in MRI volumes for their biopsy-naive patients. Currently, only 19% of respondents request MRI for over half of their patients vs. 59% who anticipate they will do so in the future. Most respondents (89%) felt that some high-risk patients could proceed directly to biopsy if they were sufficiently high-risk, but this varied by prostate-specific antigen (PSA) threshold, palpable extra-prostatic extension, and risk calculator score. For urologists and radiologists combined, the highest-rated barriers to MRI were inadequate infrastructure, reimbursement, and volume/expertise. Most also agreed that there would be increased system-level costs, although patients would have reduced discomfort and complications; 66% of urologists felt that pre-biopsy MRI would lead to a long delay (1–3 months) in PCa diagnosis compared to only 27% of radiologists.
Conclusions: The implementation of MRI for the diagnosis of PCa in biopsy-naive patients will substantially impact the Canadian healthcare system, with the majority of urologists expecting that they will order MRI for more than half their patients. However, most respondents agreed that some high-risk patients could be streamlined directly to biopsy to conserve limited resources. Finally, barriers in MRI infrastructure, reimbursement, and expertise remain to be addressed.
