Tracking Changes in Clinical Practice Patterns Following Prebiopsy Biparametric Prostate MRI

Rationale and Objectives: To evaluate the change in clinical practice after implementation of prebiopsy biparametric MRI followed by targeted biopsy and the benefits of prebiopsy MRI based on real clinical practice. Materials and Methods: A total of 1,661 patients who underwent either transrectal biopsy or prebiopsy MRI for suspected prostate cancer between October 2015 and March 2018 were enrolled in this retrospective single-center study. To evaluate temporal changes in clinical practice, the study time was divided into five periods of six months. Prebiopsy prostate MRI was officially started in April 2016 in this center. Differences in practice patterns were compared among the five periods, and differences in biopsy results were compared in three groups: no prebiopsy MRI, negative MRI and positive MRI. Results: Prostate cancers were diagnosed in 463 patients. The proportion of patients who underwent prebiopsy MRI regardless of biopsy increased from 22.6% in period 1 to 84.4% in period 5 (P < 0.001). The proportion of patients who avoided biopsy according to MRI results increased significantly from 9.0% in period 1 to 48.1% in period 5 (P < 0.001). The prostate cancer detection rate and the number of positive cores were lower in the negative MRI group than those in the positive MRI and no prebiopsy MRI groups. Conclusion: Prebiopsy MRI using biparametric MRI protocol has been well adapted to the practice and it is useful in stratifying the probability of clinically significant prostate cancer.