Results from a PI-RADS-based MRI-directed diagnostic pathway for biopsy-naive patients in a non-university hospital.

To assess the safety and performance of a MRI-directed diagnostic pathway for patients with first-time suspicion of prostate cancer in a non-university hospital.

Between May 2017 and December 2018 all biopsy-naive patients examined in our hospital followed a MRI-directed diagnostic work-up algorithm based on PI-RADS score. In short, PI-RADS 1-2 was generally not biopsied and PI-RADS 3-5 was reviewed by a multidisciplinary team. Patients with PI-RADS 4-5 were all referred to biopsy, either transrectal ultrasound-guided biopsy or MRI in-bore biopsy for small tumors and for sites difficult to access. PI-RADS scores were compared to the histopathology from biopsies and surgical specimens for patients who had prostatectomy. Non-biopsied patients were referred to a safety net monitoring regimen.

Two hundred and ninety-eight men were enrolled. 97 (33%) had PI-RADS 1-2, 44 (15%) had PI-RADS 3, and 157 (53%) had PI-RADS 4-5. 116 (39%) of the patients avoided biopsy. None of these were diagnosed with significant cancer within 2-3.5 years of safety net monitoring. Almost all high ISUP grade groups (≥ 3) were in the PI-RADS 4-5 category (98%). Prostatectomy specimens and systematic biopsies from MRI-negative areas indicated that very few clinically significant cancers were missed by the MRI-directed diagnostic pathway.

Our findings add to evidence that a MRI-directed diagnostic pathway can be safely established in a non-university hospital. The pathway reduced the number of biopsies and reliably detected the site of the most aggressive cancers.

Abdominal radiology (New York). 2021 Aug 20 [Epub ahead of print]

Jeroen S Reijnen, Jon B Marthinsen, Alf O Tysland, Christoph Müller, Irina Schönhardt, Erlend Andersen, Therese Seierstad, Knut H Hole

Department of Radiology, Sørlandet Hospital, Kristiansand, Norway., Department of Urology, Sørlandet Hospital, Kristiansand, Norway., Department for Cancer Treatment, Sørlandet Hospital, Kristiansand, Norway., Department of Pathology, Sørlandet Hospital, Kristiansand, Norway., Division of Radiology and Nuclear Medicine, Radiumhospitalet, Oslo University Hospital, P.o.box 4950, Nydalen, Oslo, Norway. ., Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

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