Introduction

Several guidelines recommend multiparametric magnetic resonance imaging (mpMRI) in the prostate cancer (PCa) pathway before an initial prostate biopsy (Bx). The objective was to assess the feasibility of implementing a new PCa diagnostic pathway with the addition of mpMRI in a real-world setting.

Methods

A committee involving stakeholders (e.g. urologists, radiologists, managers) was created to review the PCa diagnostic pathway for Bx-naïve patients. The new pathway includes initial consultation with urologist and mpMRI exam when recommended. Men recommended Bx after mpMRI had both targeted three-dimensional transrectal ultrasound-MRI fusion Bx and systematic Bx. Data were collected between September 2021 and June 2022. A cohort of 629 Bx-naïve patients who underwent an initial systematic Bx in 2017 without mpMRI was the comparison group. Clinically significant PCa (csPCa) was defined as Grade Group ≥ 2.

Results

A total of 1336 Bx-naïve patients were referred to urologist: follow-up was recommended for 703 (53%), systematic Bx for 254 (19%) and mpMRI for 379 (28%). Among patients who had biopsies in the new pathway, csPCa was diagnosed in 246/427 (58%) patients referred to mpMRI or directly to systematic Bx compared to 274/629 (44%) patients in the 2017 cohort (p<0.0001). The new PCa diagnostic pathway prevented 33% of patients from having Bx. Shorter delays between initial consultation with urologists and transmission of Bx results were observed for patients referred directly for prostate Bx compared to mpMRI before Bx (mean: 2.8 vs 9.1 months).

Conclusions

Implementation of the new PCa diagnostic pathway with the addition of mpMRI in a real-world setting has highlighted the added value of the early involvement of urologists for the triage of Bx-naïve patients, limited the use of mpMRI and yet avoided unnecessary Bx and increased csPCa detection. Accessibility to prostate mpMRI remains a major limitation to the implementation of this new diagnostic pathway.