MRI Improves Detection of Prostate Cancer

MedicalResearch.com Interview with:

Dr. Vikas Gulani MD, PhD Director, MRI, University Hospitals Case Medical Center Associate Professor, Radiology CWRU School of Medicine Cleveland, OH

Dr. Vikas Gulani

Dr. Vikas Gulani MD, PhD
Director, MRI, University Hospitals Case Medical Center
Associate Professor, Radiology
CWRU School of Medicine
Cleveland, OH 

MedicalResearch.com: What is the background for this study?

Dr. Gulani: For men that have a suspicion for prostate cancer either via the prostate specific antigen (PSA) test or a digital rectal exam, the current standard of care is to perform a transrectal ultrasound (TRUS) guided biopsy to detect cancer. The problem with TRUS biopsy is that most tumors are not visible on ultrasound and hence many significant cancers are missed. At the same time this strategy detects a high number of low risk, indolent cancers, and leads to overtreatment of disease that would be better left untreated.

Diagnostic MRI and MRI-guided biopsy (cognitive, ultrasound-MR fusion, or in-gantry) have been shown to be effective in detecting clinically significant prostate cancer. However, despite these advantages there is reluctance to incorporate MRI into standard practice because it is perceived to be expensive. Our goal was to determine if this presumption is true, and evaluate the cost-effectiveness of the MRI-guided techniques most commonly used.

MedicalResearch.com: What are the main findings?

Dr. Gulani: We found that every MRI strategy we evaluated was cost-effective compared to standard biopsy. Cognitive MRI guided biopsy – where the operator performs an ultrasound biopsy based on knowledge of lesion location from the MRI – was the most cost-effective strategy compared to standard biopsy. In-gantry MRI yielded the highest net health benefits as measured in quality adjusted life years.

MedicalResearch.com: What should readers take away from your report?

Dr. Gulani: Improvement in detection of prostate cancer using MRI appears to provide substantial benefit to the patient and is likely to outweigh the marginal increase in costs. The simple strategy of performing MRI to decide on whether to perform a biopsy at all, followed by simple cognitive guidance could be readily adopted clinically without purchase of specialized equipment or training.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Abstract presented at the May  2016 AUA conference:

Cost Effectiveness of MRI Before Prostate Biopsy
Shivani Pahwa*, Nicholas Schiltz, Lee Ponsky, Ziang Lu, Sara Dastmalchian, Robert Abouassaly, Mark Griswold, Vikas Gulani, Cleveland, OH

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