Wei Gavin, Reeves Fairleigh, Perera Marlon, Kelly Brian D, Esler Stephen, Bolton Damien, Jack Greg
Department of Surgery Austin Health, The University of Melbourne Melbourne Victoria Australia.
Olivia Newton-John Cancer and Wellness Centre Austin Health Heidelberg Victoria Australia.
BJUI Compass. 2022 Feb 11;3(4):304-309. doi: 10.1002/bco2.140. eCollection 2022 Jul.
From 1 July 2018, the Australian Medicare Benefits Schedule (MBS) introduced rebates for multi-parametric magnetic resonance imaging (mpMRI) for the workup for prostate cancer (PCa). We aimed to determine if subsidisation of mpMRI prior to transperineal biopsy altered our institution's prostate biopsy practice patterns and outcomes.
All patients who underwent transperineal prostate biopsy at an Australian tertiary institution from 1 January 2017 to 1 January 2020 were identified. Patients with known PCa were excluded. Patients were stratified into two groups: a pre-subsidisation cohort comprising patients biopsied prior to the introduction of mpMRI subsidisation on 1 July 2018 and a post-subsidisation cohort comprising patients biopsied after 1 July 2018. Histopathological results were compared with further stratification based on mpMRI results. Clinically significant cancer was defined as ISUP Grade Group ≥ 2.
Six hundred and fifty men fulfilled the inclusion criteria. Three hundred and sixty-one patients were in the pre-subsidisation cohort and 289 in the post-subsidisation cohort. Of the patients in the pre-subsidisation group, 36.3% underwent a pre-biopsy mpMRI compared with 77.5% in the post-subsidisation group. Of the patients in the pre-subsidisation group, 59.6% had positive biopsies ( = 0.024) compared with 68.2% in the post-subsidisation group. The rate of clinically significant PCa was lower in the pre-subsidisation group (39.1%) compared with the post-subsidisation (49.5%, = 0.008). The negative predictive value of mpMRI for clinically significant PCa was 86.5%.
Our institution experienced a reduction of negative prostate biopsies and an increase in clinically significant PCa within transperineal biopsy specimens after the Australian healthcare system introduced financial subsidisation of mpMRI.
自2018年7月1日起，澳大利亚医疗保险福利计划（MBS）开始为前列腺癌（PCa）检查中的多参数磁共振成像（mpMRI）提供回扣。我们旨在确定在经会阴活检前对mpMRI进行补贴是否会改变我们机构的前列腺活检实践模式和结果。
确定了2017年1月1日至2020年1月1日在澳大利亚一家三级机构接受经会阴前列腺活检的所有患者。已知患有PCa的患者被排除。患者被分为两组：补贴前队列，包括在2018年7月1日mpMRI补贴引入之前接受活检的患者；补贴后队列，包括在2018年7月1日之后接受活检的患者。根据mpMRI结果进一步分层比较组织病理学结果。临床显著癌定义为国际泌尿病理学会（ISUP）分级组≥2级。
650名男性符合纳入标准。补贴前队列中有361名患者，补贴后队列中有289名患者。补贴前组中，36.3%的患者在活检前进行了mpMRI检查，而补贴后组中这一比例为77.5%。补贴前组中，59.6%的患者活检结果为阳性（P = 0.024），而补贴后组中这一比例为68.2%。补贴前组临床显著PCa的发生率（39.1%）低于补贴后组（49.5%，P = 0.008）。mpMRI对临床显著PCa的阴性预测值为86.5%。
在澳大利亚医疗系统对mpMRI进行财政补贴后，我们机构经会阴活检标本中前列腺活检阴性率降低，临床显著PCa的发生率增加。
