(UroToday.com) The uptake of a rapid and streamlined diagnostic approach for suspected prostate cancer is growing. The use of pre-biopsy multiparametric MRI in a patient with suspected prostate cancer can lead to additional time in the diagnostic pathway and regional variation.
In this study, the authors report the updated outcomes from the one-stop rapid access to prostate imaging and diagnosis (RAPID) pathway, introduced in three distinct hospitals. This pathway streamlines the standard diagnostic pathway into either one or two visits using multiparametric MRI to triage men to a same day transperineal targeted and systematic biopsy if required.
A total of 1,719 men were streamlined in the RAPID pathway between April 2017 and July 2019. All men were clinically reviewed and underwent a multiparametric MRI on the same day. A trans-perineal prostate biopsy was offered if the MRI score was four or above, or patients had a score of three or above with a PSA density of 0.12 or above. For the purpose of this study, significant prostate cancer was defined as Gleason 3 + 4 or above.
The diagnostic outcome of the analyzed men is shown in Figure 1. The median age was 66, and the median PSA was 6.7. 47% of patients had non-suspicious multiparametric MRI while 6% of the men underwent a prostate biopsy revealing any cancer in 2% and significant cancer in 1% of the men. 49% of the patients underwent a transperineal biopsy due to a suspicious multiparametric MRI. 76% of these men were ultimately diagnosed with any kind of prostate cancer, and 54% had clinically significant prostate cancer. Of the patients with a negative prostate biopsy, 30% of them had known causes of MRI false positives, which included either inflammation or atrophy.
Figure 1 – Diagnostic outcome of referred patients:
7 patients who constitute 0.8% developed acute urinary retention following the transperineal prostate biopsy. Three patients who constituted 0.4% required catheterization for bleeding and one patient had cultured proven urinary tract sepsis.
The authors believe that this data showing the use of the multiparametric MRI in a rapid access pathway leads to a significant reduction in the overdiagnosis of insignificant prostate cancer. It also leads to a substantial increase in the detection of significant prostate cancer, and many men can avoid a prostate biopsy altogether through this pathway.
The authors concluded that RAPID remains a safe and effective pathway for the diagnosis of suspected prostate cancer. This MRI triage approach allows two in five men to avoid an immediate biopsy whilst one in two men who undergo a prostate biopsy is eventually diagnosed with clinically significant disease.
Presented by: Edward Bass, Doctoral Research Fellow, Division of Cancer, Imperial College London, London, England
Written by: Hanan Goldberg, MD, MSc., Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA, Twitter: @GoldbergHanan, at the 2020 American Urological Association (AUA) Annual Meeting, Virtual Experience #AUA20, June 27- 28, 2020