MRI-Guided Strategies Offers Cost-Effective Method for Prostate Cancer Detection

MRI-guided strategies are a cost-effective method to detect prostate cancer, a new study suggests.

The current standard of care for prostate cancer detection is an invasive transrectal ultrasound-guided biopsy that involves the collection of 12 biopsy samples.

Unfortunately, a large proportion of tumors are not visible in an ultrasound and results in up to 40% of clinically significant tumors that are missed. Furthermore, many tumors that are found are clinically insignificant, and leads to many patients undergoing treatment for low-risk tumors.

In a new study published in Radiology, investigators found that using a diagnostic MRI to detect lesions and guide biopsies increased standardized quality-adjusted life years for patients. It was cost-effective in 94.05% of simulations, and the health benefits were consistent across the age groups.

MRIs offer a non-invasive alternative to transrectal ultrasound that can help better steer biopsy pathways, and could change the prostate cancer detection landscape.

Physicians could use MRI to search for potentially harmful lesions in patients. The information could then be used in 1 of 3 MRI-guided strategies for biopsying potential foci of cancer and eliminating the need for a biopsy if the scan comes back negative.

Although scans are expensive, they provide many useful health benefits. Overtreatment is a major contributor to high health and financial costs in prostate cancer, and MRIs tend to miss low-risk cancer. Additionally, a negative MRI is a good predictor of exclusion of aggressive disease.

“Many consider MRIs to be cost-prohibitive, especially when evaluating for a common entity such as prostate cancer,” said study advisor Vikas Gulani, MD, PhD. “This was our expectation as well, prior to doing this work, but our study found the opposite. We found that performing MRI before biopsy and using that information to alter biopsy pathways would be a strategy that would add health benefits to the patient population in a cost-effective manner.”

The cost-effectiveness of the MRI-guided strategies is most likely attributed to the combination of these factors, according to the investigators.

In the United States, the estimated cost of care for prostate cancer is more than $10 billion per year, and the price continues to rise.

“Costs are escalating in part due to expensive and inefficient diagnostic pathways, and placement of patients in incorrect treatment groups,” Gulani said. “If we can maximize efficiency in how we identify clinically significant lesions and diagnose patients, we can reduce unnecessary treatments for our patients, and reduce costs to our hospitals.”