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. 2023 Aug 1;6(8):e2330233.
doi: 10.1001/jamanetworkopen.2023.30233.

Frequency of Biopsy and Tumor Grade Before vs After Introduction of Prostate Magnetic Resonance Imaging

David Robinson  1 , Rafid Abdulkareem  1 , Delshad Nasrollah  1 , Anders Ljung  2 , Per Hintze  2 , Sara Wallby  2 , Henriettæ Ståhlbrandt  2 , Thorun Frennvall  3 , Johan Styrke  4 , Pär Stattin  5 , Hans Garmo  5
Affiliations

Frequency of Biopsy and Tumor Grade Before vs After Introduction of Prostate Magnetic Resonance Imaging

David Robinson et al. JAMA Netw Open. .

Abstract

Importance: In randomized clinical trials (RCTs), magnetic resonance imaging (MRI) before prostate biopsy has been associated with fewer biopsies, decreased detection of Gleason score 6 cancers, and increased detection of Gleason score 7 or higher cancers.

Objective: To study whether MRI of the prostate before the decision to biopsy is associated with biopsy frequency and distribution of Gleason score in clinical practice.

Design, setting, and participants: This is a retrospective, population-based cohort study of men in Jönköping Region, Sweden. Men with prostate-specific antigen (PSA) level measured between November 2011 and 2020 were monitored until January 31, 2021. Men with known prostate cancer were excluded. Data analysis was performed from July to December 2022.

Exposures: Data on repeated PSA measures, prostate biopsies, and MRI prostate were extracted from health care records, and cancer characteristics were obtained from The National Prostate Cancer Register.

Main outcomes and measures: The proportions of men who underwent prostate biopsy and risk of Gleason score 6 or Gleason score 7 or higher cancer and negative biopsy before and after introduction of MRI were calculated.

Results: In this cohort study of 23 802 men (mean [SD] age, 60.8 [13.6] years) who underwent PSA testing, when the use of MRI increased, fewer biopsies were performed (adjusted odds ratio [OR], 0.84; 95% CI, 0.72-0.97) and the odds of detecting Gleason score 6 cancer decreased (OR, 0.47; 95% CI, 0.33-0.64), whereas the odds of detecting Gleason score 7 or higher cancer increased (OR, 1.24; 95% CI, 1.02-1.50).

Conclusions and relevance: In this study, the introduction of MRI to clinical practice was associated with a decreased proportion of men who underwent a biopsy and decreased detection of Gleason score 6 cancer but increased detection of Gleason score 7 or higher cancer. These clinical data support the use of prostate MRI before biopsy in an effort to avoid unnecessary biopsies.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Use of Prostate Magnetic Resonance Imaging (MRI) Over Time
Graph shows proportion of MRIs performed as a function of the first prostate-specific antigen (PSA) value on November 1, 2015, to July 31, 2020, for all men, and for men with PSA between 3 and less than 20 ng/mL according to age groups. To convert PSA to micrograms per liter, multiply by 1.
Figure 2.
Figure 2.. Workup Within 180 Days After the First Prostate-Specific Antigen (PSA) Test Among Men in Jönköping Region, Sweden, 2015-2020
Graphs show data for men with PSA level between 3 and less than 20 ng/mL (A) and men with any PSA level (B). This categorization was hierarchical, and a man could be registered with only 1 workup. To convert PSA to micrograms per liter, multiply by 1. MRI indicates magnetic resonance imaging.
Figure 3.
Figure 3.. Outcomes of Biopsies
Graphs show the outcome of the biopsies as proportions of men (A) and incidence per 100 000 estimated total population (B), according to Gleason score (GS). Clinical diagnosis means that no biopsy was performed, and the findings were benign.
See this image and copyright information in PMC

Comment in

References

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