SIU-WJU Article of the Month – June 2019
Clinical applications of multiparametric MRI within the prostate cancer diagnostic pathway
SIU Academy®. Ren S. Jun 4, 2019; 273470
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Multiparametric magnetic resonance imaging (mpMRI) improves clinically significant prostate cancer (csPCa)
detection by facilitating targeted biopsy (cognitive, fusion technology, or in-gantry MRI guidance) and reducing negative
biopsies. This study sought to describe the feasibility of introducing an mpMRI-based triage pathway, including diagnostic performance, applicability to training, and cost analysis.


An observational retrospective cohort study of consecutive patients attending a large public tertiary referral training
hospital who underwent mpMRI for suspicion of prostate cancer was considered. Standard clinical, MRI-related, histopathological, and financial parameters were collected for analysis of biopsy avoidance, diagnostic accuracy of biopsy approach, and operator (consultant and resident/registrar) and logistical (including financial) feasibility.


653 men underwent mpMRI, of which 344 underwent prostate biopsy resulting in a 47% biopsy avoidance rate.
Overall, 240 (69.8%) patients were diagnosed with PCa, of which 208 (60.5%) were clinically significant, with higher rates of csPCa observed for higher PIRADS scores. In patients who underwent both systematic and targeted biopsy (stTPB), targeted cores detected csPCa in 12.7% and 16.6% in more men than systematic cores in PIRADS 5 and 4, respectively, whereas systematic cores detected csPCa in 5% and 3.2% of patients, where targeted cores did not. A high standard of performance was maintained across the study period and the approach was shown to be cost effective.


Introdution of an mpMRI-based triage system into a large public tertiary teaching hospital is feasible, cost
effective and leads to high rates of prostate cancer diagnosis while reducing unnecessary biopsies and detection of insignificant PCa.


Prostate cancer · Multiparametric MRI · Transperineal prostate biopsy · Cognitive-fusion prostate biopsy ·
Systematic prostate biopsy · Prostate imaging reporting and data system
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