Objectives
To determine the feasibility of Bi-parametric magnetic resonance imaging (BP-MRI) based screening for prostate cancer detection compared with standard digital rectal examination (DRE) and prostate-specific antigen (PSA)-based screening.
Patients and Methods
Retrospective review of consecutive 102 men who underwent standard DRE and PSA-based prostate cancer screening in conventional screening group from July, 2014 to June, 2015 and 121 men who underwent BP-MRI in addition to standard DRE and PSA-based prostate cancer screening in MRI based screening group from May, 2017 to May, 2018. Among MRI based group, 91 men who had a PIRADS 3 or more lesion were considered to screening positive and then performed MR/US fusion biopsy and random prostate biopsy. Other group underwent random prostate biopsy only. Men having PSA level 20 or more were excluded in this study. Patient demographics, DRE staging, PSA level, PSA density (PSAD), BP-MRI findings association with prostate cancer detection on biopsy, rate of admission for complication after prostate biopsy and associated medical cost to performed a each screening method.
Results
Pre-biopsy demographics of both groups were comparable. MR based screening group (62.6%) could detect the more prostate cancer than conventional group (45%). MR based screening group(40.6%) also could found more clinical significant prostate cancer than the other group (25%). Among 121 men who underwent bp MRI, 30 men who had PIRADS 2 or less lesion were omitted in MR based screening groups because of absent of targetable prostate lesion. Therefore 30 men underwent systemic prostate biopsy. Their systemic biopsy results showed 23 had no cancer, 6 had G6(3+3), 1 had low volume G7(3+4) lesion. All of omitted men was considered to having insignificant prostate cancer. When calculating the cost per patient for each method, the usual method required $ 619 and the fusion method cost $ 660. Despite the increased cost of bp MRI, there was no significant difference between the two groups because of the reduction in costs due to the lack of biopsy in MR based screening group.
Conclusions
MR based screening is feasible to detect overall and significant prostate cancer than conventional methods. These can reduce to perform unnecessary biopsy to detect the insignificant prostate cancer without increasing medical cost. However, these results should be validated with prospective study.
