Original article
Current beliefs and practice patterns among urologists regarding prostate magnetic resonance imaging and magnetic resonance–targeted biopsy

https://doi.org/10.1016/j.urolonc.2016.08.008Get rights and content

Highlights

  • Respondents to survey look favorably on use of prostate MRI and MR-targeted biopsy.

  • MR-targeted biopsy most often utilized in patients with prior negative biopsy.

  • Lower cost and easier access to equipment may increase use of this technology.

Abstract

Introduction and objective

Multiparametric magnetic resonance imaging (MRI) and magnetic resonance (MR) -targeted biopsy have a growing role in the screening and evaluation of prostate cancer. We aim to evaluate the current knowledge, attitude, and practice patterns of urologists regarding this new technique.

Methods

An anonymous online questionnaire was designed to collect information on urologists’ beliefs and use of prostate multiparametric MRI and MR-targeted biopsy. The survey was sent to members of the Society of Urologic Oncology, the Endourological Society, and European Association of Urology. Multivariate logistic regression analysis was performed to determine predictors for use of prostate MRI and MR-targeted biopsy.

Results

A total of 302 responses were received (Endourological Society: 175, European Association of Urology: 23, and Society of Urologic Oncology: 104). Most respondents (83.6%) believe MR-targeted biopsy to be moderately to extremely beneficial in the evaluation of prostate cancer. Overall, 85.7% of responders use prostate MRI in their practice, and 63.0% use MR-targeted biopsy. The 2 most common settings for use of MR-targeted biopsy include patients with history of prior negative biopsy result (96.3%) and monitoring patients on active surveillance (72.5%). In those who do not use MR-targeted biopsy, the principal reasons were lack of necessary infrastructure (64.1%) and prohibitive costs (48.1%). On multivariate logistic regression analysis, practice in an academic setting (1.86 [1.02–3.40], P = 0.043) and performing greater than 25 radical prostatectomies per year (2.32 [1.18–4.56], P = 0.015) remained independent predictors for using MR-targeted biopsy.

Conclusions

Most respondents of our survey look favorably on use of prostate MRI and MR-targeted biopsy in clinical practice. Over time, reduction in fixed costs and easier access to equipment may lead to further dissemination of this novel and potentially transformative technology.

Introduction

One of the dilemmas currently faced in prostate cancer (PCa) screening and diagnosis is the overdetection of low-risk, indolent cancers that do not necessarily demand definitive treatment. This obstacle has led to a renaissance in the field, with the exploration of genomics, novel biomarkers, and imaging to bridge the deficiency [1], [2], [3]. Regarding imaging, visualization of PCa has always been challenging because of the deep location of the prostate within the pelvis, heterogenous complexity of PCa, and its multifocal nature [4]. However, recent advances in multiparametric magnetic resonance imaging (mpMRI) for prostate imaging coupled with the evolution of magnetic resonance (MR) targeted biopsy have resulted in a paradigm shift in PCa evaluation. MR-targeted biopsy, performed either “in-bore” or through cognitive or MRI-ultrasound fusion, allows for more precise sampling within the prostate, and, relative to systematic 12-core biopsy, has been repeatedly shown to identify more high-risk PCa cases while avoiding detection of low-risk disease [5], [6], [7], [8]. This, in turn, has led to improved efforts in defining tumor burden and staging PCa before definitive treatment [9], [10]. Furthermore, MR-targeted biopsy has been shown to have proven use in several different clinical scenarios, such as in those with prior negative transrectal ultrasound biopsy result, lesions in areas within the prostate that are traditionally undersampled with transrectal ultrasound biopsy (e.g., midline, anterior, and distal apical), and monitoring of patients placed on active surveillance [11], [12], [13], [14], [15].

As the potential roles for mpMRI and MR-targeted biopsy have expanded over time, the acceptance of these novel technologies within the urology community has been steadily increasing. Despite increasing use, there are still some opponents within the urology community, and the acceptance has neither been uniform nor unanimous. To our knowledge, there is no study that has attempted to determine the current attitude of the urological community toward mpMRI and MR-targeted biopsy and reasons for acceptance or opposition of this novel technology. The aim of this present study is to gauge current knowledge, opinions, and practice patterns among urologists regarding use of mpMRI and MR-targeted biopsy for screening and detection of PCa.

Section snippets

Survey instrument

After reviewing the literature on the subject, a 22-item questionnaire was designed to collect demographic data and information on urologist’s attitude and practice patterns regarding use of MRI and MR-targeted biopsy for PCa. The questionnaire was designed in a branching fashion such that respondents were taken to different follow-up questions based on how he/she responded to the previous question. Additionally, certain questions allowed respondents to “select all that apply” in response to

Results

A total of 302 responses were received, with 175 (58.0%) from ES, 23 (7.6%) from EAU, and 104 (34.4%) from SUO. Characteristics of the respondents are shown in Table 1. Mean age of the respondents was 48.6 (±11.9) years, with 143 (48.2%) trained in urologic oncology and 208 (68.9%) practicing in an academic setting. Respondents practicing in an academic setting tended to be younger (46.85 [11.62] vs. 52.27 [11.62] years, P<0.001) and more often urologic oncology fellowship trained (54.1% vs.

Discussion

The field of urology has continuously embraced novel technologies (e.g., robotics, laparoscopy, shockwave lithotripsy, and lasers) that enhance patient outcomes, reduce patient morbidity, and improve efficiency and accuracy of therapy. As with all innovation, new technology must first endure a process of initial skepticism followed by rigorous clinical evaluation and proper validation. One such example is the introduction and adoption of robotic surgery within the field of urology [16], [17].

Conclusion

Most respondents to our survey seem to look favorably on use of prostate mpMRI and MR-targeted biopsy in clinical practice. Both modalities are most commonly used in the settings of patients with prior negative biopsy result and patients placed on active surveillance. Practice in an academic setting and higher surgical volume predicted use of MR-targeted biopsy by the urologists. Reduction of cost and easier access to the necessary equipment may further increase the usage of this technology in

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    This research was supported by the Intramural Research Program of the National Institutes of Health (NIH), National Cancer Institute, Center for Cancer Research, and the Center for Interventional Oncology. NIH and Philips Healthcare have a cooperative research and development agreement. NIH and Philips share intellectual property in the field.

    This research was also made possible through the National Institutes of Health Medical Research Scholars Program, a public-private partnership supported jointly by the NIH and generous contributions to the Foundation for the NIH from Pfizer Inc., The Doris Duke Charitable Foundation, The Alexandria Real Estate Equities, Inc. and Mr. and Mrs. Joel S. Marcus, and the Howard Hughes Medical Institute, as well as other private donors. For a complete list, please visit the Foundation website at http://fnih.org/work/education-training-0/medical-research-scholars-program.

    1

    These authors contributed equally.

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