Multiparametric MRI (mpMRI) has been of immense benefit to prostate cancer patients. Pre-biopsy mpMRI has spared countless men from unnecessary biopsy. When biopsy is called for, real time in-bore mpMRI allows selective targeting of the suspicious area, which means only a minimal number of needles. Identifying the location of clinically significant prostate cancer (PCa) has made tailored treatment possible for patients who are focal therapy candidates.

With all these benefits, who could have predicted that this advanced imaging would put stress on medical providers and healthcare systems?

The impact of increased demand

A team of urologists published an articulate description mpMRI’s impact on the world of PCa clinicians, both urologists and radiologists. Their article, “Interpreting Prostate MRI Reports in the Era of Increasing Prostate MRI Utilization: A Urologist’s Perspective,” cites important data and describes resulting situations.^[i] Here are a few samples with quotes from the article:

1. In the pre-MRI era, men with a suspiciously high or rising PSA were routinely rushed into a TRUS-guided biopsy. This biopsy method, using 12-14+ needles, had a false negative rate as high as 76%, causing harm. mpMRI changed all that with the capacity to determine if biopsy is needed or not.

“As a result, the latest 2023 European Association of Urology (EAU) guidelines recommend prostate MRI in asymptomatic men with PSA 3–10 ng/mL and normal DRE.” In other words, a pre-biopsy MRI.

2. IF every man with a suspiciously high PSA has an mpMRI, an unprecedented number of scans will be ordered. To be accurate, they must be high-quality (3T MRI is the gold standard) and interpreted by experienced readers. This creates a need to expand the number and location of imaging centers that are equipped with up-to-date magnets. In many cases, rural and economically under-advantages areas will have less accessibility to mpMRI.

“This is predicted to equate annually to approximately two million additional prostate MRI scans.”

3. Additionally, insurance may not cover pre-biopsy MRI. Though not cited by the article, Booker, et al. (2019) state, “Prostate MRI coverage varies widely among private payers, fails to recognize major clinical scenarios, is overly restrictive, and is often not reflective of current clinical practice. This creates challenges for patients and referring physicians seeking to obtain ready access to prostate MRI services.”^[ii]
4. The increase in demand for scans puts pressure on utilization by imaging centers. More importantly, the article discusses the drain on human resources.

“The demand for radiologists with expertise in prostate MRI interpretation also grows. Ensuring a sufficient number of qualified radiologists is essential to maintain the accuracy and reliability of prostate MRI reports.”

5. The authors note the fact that not all readers are equally experienced at interpreting prostate MRI scans. To offset this, experts have created—and continue to update—standards of capturing images, reading them, and reporting the data. The most widely used system is the PI-RADS (Prostate Imaging Reporting and Data System). Since PI-RADS was introduced in 2012, subsequent versions have improved the detailed guidelines.

“However, the practical implementation of PIRADS reporting in routine clinical practice presents a multifaceted challenge, encompassing interpretative complexity, interobserver variability, and the need for continuous training and refinement.”

First, let me say that the Sperling Prostate Center is proud to be among the premier international prostate imaging centers. We have a state-of-the-art 3T magnet, and a team of expert clinicians and staff. In addition to highly accurate mpMRI-based detection and diagnosis, our mpMRI-guided treatments, like Focal Laser Ablation or TULSA, are second to none, because of our pioneering early adoption of prostate MRI at the very start of the MRI era.

Second, we like the vision of urologists who wrote the article: “In this era of precision medicine, where tailored treatments are becoming the norm, the dialog between radiologists and urologists must evolve to meet the demands of a rapidly advancing field. The goal is clear: to ensure that every patient receives the most accurate diagnosis, appropriate treatment, and the best possible outcome.”

We strive to network and connect with our colleagues in both specialties, knowing that open exchange of information is to the good of our patients. As early adopters of AI assistance in imaging, we also believe that the ongoing development of larger and more precise AI programs that incorporate the knowledge of experts will lessen reader work without interfering with the doctor’s decision-making role.

Still, if a patient can have access to expert human imaging and interpretation, we believe it’s in the patient’s best interest. That’s what we’re here for. Contact us to learn more about our services.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Miszewski K, Skrobisz K, Miszewska L, Matuszewski M. Interpreting Prostate MRI Reports in the Era of Increasing Prostate MRI Utilization: A Urologist’s Perspective. Diagnostics (Basel). 2024 May 20;14(10):1060.
[ii] Booker MT, Silva E 3rd, Rosenkrantz AB. National Private Payer Coverage of Prostate MRI. J Am Coll Radiol. 2019 Jan;16(1):24-29.