Urology Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK.
Urology Unit, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy.
World J Urol. 2024 Feb 15;42(1):82. doi: 10.1007/s00345-024-04772-1.
Prostate mpMRI was introduced in 2011 as a secondary test and subsequently integrated into a prostate cancer (PCa) diagnostics unit representing a population of approximately 550,000 people. The following represents an audit of its step-wise introduction between 2 index years, 2009 and 2018, focusing on the activity, patient outcomes and economic benefits. PATIENTS AND METHODS: The 2 distinct years were selected for relying on a transrectal ultrasound biopsy pathway in 2009 to an mpMRI-based pathway in 2018. All referrals were retrospectively screened and compared for age, PSA levels, DRE findings, biopsy history, biopsy and mpMRI allocation data. Cost analysis was determined using local unit procedure costs.
Patients referred included 648 in 2009 and 714 in 2018. mpMRI seldomly informed decision to biopsy in 2009 (9.8%), while in 2018 it was performed in the pre-biopsy setting in 87.9% cases and enabled biopsy avoidance in 137 patients. In 2018, there was a 31.8% decrease in the number of biopsies in patients without previous PCa diagnosis, coupled with an increase in diagnostic rates of csPCa, from 28.6 to 49.0% (p < 0.0001) and a reduction in negative biopsy rates from 52.3 to 33.8%. mpMRI had a positive impact on the system with reduced patient morbidity and post-procedural complications. The estimated overall cost savings amount to approximately £75,000/year for PCa diagnosis and £11,000/year due to reduced complications.
Our evaluation shows the mpMRI-based pathway has improved early detection of csPCa and reduction of repeat biopsies, resulting in significant financial benefits for the local healthcare system.
前列腺多参数磁共振成像（mpMRI）于 2011 年作为辅助检查手段引入，并随后整合到前列腺癌（PCa）诊断单元中，该单元代表了约 55 万人的人群。以下是对其在 2009 年和 2018 年两个索引年内逐步引入的情况进行的审核，重点关注活动、患者结局和经济效益。
这两年是为了依靠 2009 年的经直肠超声活检途径和 2018 年的 mpMRI 途径而选择的。所有转诊患者均进行了回顾性筛查，并比较了年龄、PSA 水平、直肠指检发现、活检史、活检和 mpMRI 分配数据。使用当地单位程序成本进行成本分析。
2009 年转诊患者 648 例，2018 年转诊患者 714 例。2009 年，mpMRI 很少影响活检决策（9.8%），而 2018 年，mpMRI 在活检前进行，87.9%的患者可避免活检。2018 年，无前列腺癌既往诊断患者的活检数量减少了 31.8%，同时 csPCa 的诊断率从 28.6%增加到 49.0%（p<0.0001），阴性活检率从 52.3%降至 33.8%。mpMRI 对系统产生了积极影响，降低了患者发病率和术后并发症。估计每年用于 PCa 诊断的总体节省约 75000 英镑，由于并发症减少，每年节省约 11000 英镑。
我们的评估表明，基于 mpMRI 的途径提高了 csPCa 的早期检出率，并减少了重复活检，为当地医疗保健系统带来了显著的经济效益。
