It’s time to silence the economic naysayers who claim that multiparametric MRI (mpMRI) is too expensive for detecting and diagnosing prostate cancer. Results from a new study out of Brigham and Women’s Hospital[i] (Boston, MA) in partnership with AdMeTech reflect how the Sperling Prostate Center has been ahead of its time. The study demonstrates how much money prostate MRI saves by preventing the hidden costs of 1) misdiagnosis, 2) overtreatment of men who otherwise qualify for Active Surveillance (AS) and 3) managing post-treatment side effects of surgery and radiation. For over two years, many of our articles and blogs have addressed this issue. Let’s look more closely at the savings.
Misdiagnosis is expensive
The conventional diagnostic pathway moves from an abnormally high or rising PSA blood test result, into a transrectal ultrasound (TRUS) guided prostate biopsy using 12+ needles. Since TRUS can’t distinguish tumors from healthy prostate tissue, the biopsy is basically random and blind. While the in-office procedure is relatively inexpensive, the following TRUS biopsy outcomes happen all too often:
- The biopsy misses prostate cancer about 30% of the time
- The biopsy captures insignificant prostate cancer but misses aggressive disease
- The biopsy often fails to sample tissue at the apex of the gland
- If the biopsy is negative but PSA continues to rise, patients will have at least one repeat biopsy
- The number of TRUS biopsy needles increases risk of infection and erectile dysfunction
- Some post-biopsy infections require hospitalization
These are expensive mistakes and risks that burden the healthcare system, while putting underdiagnosed patients in danger of disease progression.
mpMRI corrects for these problems. It detects the size, shape, location and even aggression level of suspicious tumors. If none are seen, no biopsy is needed at that time, and a baseline MRI is obtained for future comparison and monitoring. If a suspicious lesion indicates biopsy need, the in-bore MRI-guided targeted biopsy that we offer uses the minimum number of needles (reduces infection and side effect risks) to capture cells from the most aggressive areas (most accurate diagnosis).
Overtreatment is expensive
When TRUS biopsy captures Gleason 3+3 cancer, the question arises as to whether AS is appropriate for that individual. In many cases, the answer is yes – but urologists have been taught that prostate cancer is multifocal, and there’s always the risk that the biopsy missed the most aggressive cells. To play it safe, thousands of patients each year who otherwise qualify for AS or a focal treatment have instead undergone radical prostatectomy or radiation at the recommendation of their doctor. In one informal hospital survey of prostatectomy billing, including hospital stay and complications, the price “ranged from a high of $135,000 to a low of about $10,000. Physician fees varied from $4000 up to about $19,000. The average cost for a physician or for a surgeon was about $8000.”[ii] Thus, needless surgery for men who could have gone on AS spends big medical dollars. And the average price tag for radiation is tens of thousands higher.
mpMRI significantly reduces the medical costs of overtreatment and complications requiring hospitalization. The Brigham and Women’s Hospital study demonstrated that of the patients who had TRUS biopsy, 42% were overtreated, compared with only 9% of men who had MRI.
Managing post-treatment side effects is expensive
The two most common side effects of whole-gland treatments are urinary problems (incontinence and retention) and erectile dysfunction (ED). In the majority of cases, incontinence is resolved in 3-18 months, but for men who suffer with permanent incontinence, one estimate places the price of pads and undergarments at nearly $1000 per year.[iii] ED is also pricey to manage, as anyone who takes oral medication or injections can attest. The psychological cost, however, is harder to measure. Both incontinence and ED affect a man’s masculinity, self-esteem, relationships and emotional health, taking a huge toll on quality of life.
mpMRI facilitates matching treatment, including surveillance, to disease. This means thousands of patients can be safely qualified for Active Surveillance, and monitored by a combination of PSA and mpMRI in order to stay on surveillance as long as safely possible. It means thousands of patients can be appropriately qualified for a focal therapy such as the Focal Laser Ablation offered at our Center, in order to control the tumor with minimum-to-zero risk of side effects. It means far fewer urinary and sexual side effects by avoiding overtreatment – for an estimated savings of $200 million annually in Massachusetts alone, according to the Brigham and Women’s Hospital study.
For those who still think that TRUS biopsy is less expensive than MRI, a study by deRooij et al. (2014) found that the long-term costs of TRUS biopsy vs. MRI targeted biopsy are basically equal. They compared quality of life and health care costs of both methods, included the cascading and cumulative effects over 10 years after an initial biopsy by either method. The raw healthcare costs were comparable, but the quality of life for those in the MRI-targeted biopsy group was significantly better. This was attributed to the decrease in overdiagnosis and overtreatment of the patients in that group.
The bottom line is this: mpMRI offers a diagnostic, treatment and financial savings. The Sperling Prostate Center has been ahead of the academic studies in providing patients and the medical system with cost-saving diagnosis and the ability to tailor treatment to the disease, thanks to our pioneering experience with mpMRI.