Comparison of prostate cancer detection rate at targeted biopsy of hub and spoke centers mpMRI: experience matters.

Latest changes in European guidelines on prostate cancer determined a widespread of multiparametric magnetic resonance imaging (mpMRI) even in less experienced centers due to an increased demand. This could decrease diagnostic accuracy of targeted biopsy (TB) since image interpretation can be challenging and requires adequate and supervised training. Therefore we aimed to evaluate the PCa detection rate on TB according to mpMRI center's volume and experience.

We retrospectively analyzed data of 737 patients who underwent mpMRI-TB at our institution. Patients were stratified according to mpMRI center: Hub (high volume>100 exams/year with dedicated radiologists and supervised training) and Spoke center (low volume<100 exams/year without dedicated radiologists and/or supervised training). Detection rate of PCa at TB and possible predictors of clinically significant PCa (csPCa) at TB. Differences in detection rate were explored using Chi-square test. Predictors of csPCa were evaluated through uni and multivariable logistic regression. The adjustment for casemix included: age, PSA, mpMRI center,lesion's location, PSA density, PI-RADS score and index lesion's size.

449 (60.9%) and 288 (39.1%) patients underwent mpMRI at a Hub or Spoke center, respectively. Hub group had higher detection rate for both any (60.3% vs 48.1%) and csPCa (46.9% vs 38.7%; all p≤0.001). After stratifying for PI-RADS score, Hub group had higher detection rate for PI-RADS score 3 (csPCA 25.2% vs. 15.7%; p 0.04) and 4 (csPCa 65.7% vs. 45.7%; p 0.001). At multivariable analyses, receiving an mpMRI scan at a Spoke center was an independent predictor for csPCa on TB (OR 0.65; p 0.04).

mpMRI performed in Hub centers provided a significantly higher PCa yield on TB. A dedicated team of experienced radiologist, a supervised training for mpMRI and a central revision of mpMRI performed in non-experienced centres are essential to avoid unnecessary and potentially harmful procedures.

Minerva urology and nephrology. 2022 Jun 29 [Epub ahead of print]

Matteo Droghetti, Lorenzo Bianchi, Caterina Gaudiano, Beniamino Corcioni, Arianna Rustici, Pietro Piazza, Carlo Beretta, Eleonora Balestrazzi, Francesco Costa, Alberto Feruzzi, Marco Salvador, Francesca Giunchi, Michelangelo Fiorentino, Rita Golfieri, Riccardo Schiavina, Eugenio Brunocilla

Division of Urology, IRCCS University Hospital of Bologna, Bologna, Italy - ., Division of Urology, IRCCS University Hospital of Bologna, Bologna, Italy., Department of Radiology, IRCCS University Hospital of Bologna, Bologna, Italy., Department of Pathology, IRCCS University Hospital of Bologna, Bologna, Italy.

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