Do you use products labeled as eco-friendly? As a consumer, do you spend your dollars on goods and services that claim to do less (or no) damage to the environment? If so, you have joined the multitude of individuals who are aware that personal choices and actions can impact air and water pollution. Since the very first Earth Day on April 22, 1970, there’s been an increasing groundswell in this direction.

In fact, according to an Oct. 14, 2021 BusinessWire bulletin, “Globally, 85 percent of people indicate that they have shifted their purchase behavior towards being more sustainable in the past five years.” There is also growing awareness of the ways in which our daily actions contribute to the emission of molecules like methane and carbon dioxide (so-called greenhouse gasses). This is known as our carbon footprint. Okay, so what does this have to do with prostate cancer (PCa)?

Prostate MRI can help reduce healthcare’s carbon footprint

No matter how ecologically-minded a person is, worrying about an upcoming prostate biopsy will interrupt any concerns about environmental threats. Suddenly, his internal environment becomes the most important thing on his mind. He is highly unlikely to wonder about the global impact of all the diagnostic and treatment healthcare he will be receiving. And yet, the medical systems designed to treat illnesses connected with global warming actually contribute significantly to greenhouse gas emissions.

In 2022, the Commonwealth Fund issued a cautionary report that said, “In the United States, the health care sector is responsible for 8.5 percent of the country’s greenhouse gas emissions, a share that has only increased over the past several years.” It went on to highlight the view that healthcare practitioners and organizations have a special obligation to reduce their emissions of greenhouse gases. An example of one hospital’s commitment to do just that is Mass General’s pledge to reach net zero emissions by 2050: “For example, all of the electricity for the hospital’s main campus now comes from renewable sources, most notably wind.”

What about Sperling Prostate Center’s specialty of prostate MRI? Is there anything we can contribute? Yes, says a multicenter study analysis of healthcare pollution due to prostate biopsies. Leapman, et al. (2023) published a paper titled “Environmental Impact of Prostate Magnetic Resonance Imaging and Transrectal Ultrasound Guided Prostate Biopsy”.^[i] They state that a prostate biopsy generates a carbon footprint that can be calculated. They examined five diagnostic scenarios: multiparametric MRI (mpMRI) of the prostate with targeted and systematic biopsies (baseline), mpMRI with targeted biopsy cores only, systematic biopsy without MRI, mpMRI with systematic biopsy, and biparametric MRI (bpMRI) with targeted and systematic biopsies. They drew data from U.S. academic medical centers, outpatient urology clinics, health care facilities, medical staff, and patients. Based on their data, they calculated the biopsy-driven emission of carbon dioxide equivalents (CO₂e). For all five scenarios, the top contributors were 1) the energy used during the scans and MRI-guided procedures, 2) staff travel, and 3) the manufacture/production of necessary supplies.

The authors estimated that a single biopsy procedure produces an estimated 80.7 kg (177.9 pounds) of CO₂e. They then explored how strategic use of MRI could reduce the burden of greenhouse gas emission by ruling out unnecessary biopsies. They concluded,

A total of 8.1 million kg (17,857,443.24 pounds) CO₂e could be avoided by performing 100,000 fewer unnecessary biopsies, which was equivalent to 4.1 million L [1,083,105.4 gallons] of gasoline consumed. The use of prostate MRI to triage prostate biopsy and guide targeted biopsy cores would save the equivalent of 1.4 million kg [3,086,471.7 pounds] CO₂ emissions per 100,000 patients, which was equivalent to 700,000 L [184,920.4 gallons] of gas consumed.

Here are the real numbers. Each year in the U.S., one million prostate biopsies are performed. A benchmark 2017 study estimated that using multiparametric MRI (mpMRI) as a triage before biopsy would result in 27% fewer biopsies.^[ii] Based on one million biopsies, that would be 270,000 less biopsies, which is 2.7 times more than the hypothetical figure of 100,000 chosen for the Leapman study. Thus, if we multiply their CO₂e figures by 2.7, that would annually mean sparing the environment:

• The equivalent of 8,333,473.59 pounds of CO₂ emissions, and
• The equivalent of 499,285.08 gallons of gas consumed.

These numbers represent a staggering impact on the environment.

At the Sperling Prostate Center, we are focused on one patient at a time. We are sensitive to each man’s personal cancer-free “ecology” with minimal “environmental impact.” That said, we applaud the eye opening study by Leapman and colleagues, to help us realize that each time we rule out an unnecessary biopsy we’re not just being patient-friendly, we’re also being eco-friendly.

Leapman said in a statement, “We hope this work adds depth to the discussion by providing concrete estimates of health care pollution and environmental impact also incurred through these procedures.”^[iii] Their work certainly expanded our own vision of men’s health to the entire planet.

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] Leapman MS, Thiel CL, Gordon IO, Nolte AC, Perecman A, Loeb S, Overcash M, Sherman JD. Environmental Impact of Prostate Magnetic Resonance Imaging and Transrectal Ultrasound Guided Prostate Biopsy. Eur Urol. 2023 May;83(5):463-471.
[ii] Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017 Feb 25:389)1007):815- 822. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2816%2932401-1
[iii] “Environmental Impact of Prostate MRI and Biopsy Considerable.” Renal&Urology News. Apr. 21, 2023.