Comparing significant prostate cancer detection rates after the introduction of pre-biopsy MRI: turning PROMIS into action

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Abstract
Introduction: Basingstoke was a participating centre in the MRC funded PROMIS trial between 2013 and 2015 recruiting 130 patients. In response to a perceived change in prostate biopsy histological grading following the introduction of pre-biopsy magnetic resonance imaging at our centre, we decided to undertake a retrospective analysis of prostate histology before and after participation in the study. Methods: We identified 206 patients in both 2012 and 2016 who had undergone prostate biopsy. We reviewed the type of biopsy performed (transrectal or transperineal), the number of cores sampled, the number of positive cores and the cancer grade. The proportion of men who had pre-biopsy multiparametric magnetic resonance imaging was also recorded. Results: Although the total numbers undergoing biopsy were equivalent in 2012 and 2016, 37% of all patients undergoing biopsy underwent a transperineal template biopsy in 2012, increasing to 54% in 2016. The overall percentage of positive biopsy results (Gleason score ⩾3+3) increased from 70% to 83.0% (χ2=9.83, P=0.002). While the number of grade group 1 cancers significantly decreased from 63.9% (2012) to 22% (2016), there was a corresponding increase in the number of grade group 3 or higher cancers detected from 11% to 51%. In 2012, 33% of patients had multiparametric magnetic resonance imaging prior to biopsy compared with 90% in 2016. The pre-biopsy magnetic resonance imaging improved the cancer detection rates for both methods of biopsy sampling. Conclusion: Our study has confirmed that the introduction of pre-biopsy multiparametric magnetic resonance imaging can improve diagnostic accuracy and reduce the number of insignificant cancers detected. This overall upgrading of the biopsied population, and the resulting shift towards detecting an increased number of significant cancers, is likely to have a positive impact on treatment allocation and longer-term outcomes for our patients. This effect should be reproducible in other centres. Level of evidence: Not applicable for this multicentre audit.

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