Sperling Prostate Center

Prostate MRI: A Better Value than TRUS Biopsy

“I can’t afford it.” Unless you’re an impulse buyer, no matter how attractive a purchase looks you’re going to take the cost into account. Will your budget accommodate your desire? Of course, there strategies that can bring you closer to getting what you want. For example, you can:

  • Shop around and compare prices for the same item
  • Spend less for a similar item such as an off-brand or knock-off
  • Wait for a sale
  • Do the cost-effective math. Will you get the best results over time for the money you spend today?

If you’re a savvy shopped, you look for ways to get the most bang for your buck.

Healthcare costs are rising. Similar to the above, hospitals and medical centers constantly look for ways to economize without sacrificing quality results for patients. Understanding the value of 3T multiparametric MRI in the prostate cancer (PCa) diagnostic pathway can help make it more available for the large population of men at risk for PCa.

MRI in the prostate cancer diagnostic pathway

Let’s look at the math. Roughly one man in eight will be diagnosed with PCa in his lifetime. The estimated number of men newly diagnosed with this disease in 2023 is 288,300. Despite the flaws of the PSA blood test (not specific for PCa), it’s still the PCa screening standard for the general population. However, it does not give a true picture of how many men actually have PCa. Even a consistently low PSA (less than 4.0 ng/mL) is not a reliable sign that a man does NOT have PCa. The 2004 Prostate Cancer Prevention Trial found that 15.2% of men with a low PSA result for seven years were found to have PCa on biopsy at the end of that period.[i] Add to that the fact that the conventional transrectal ultrasound (TRUS) biopsy itself is not accurate, since it tends to overdetect insignificant cancer and underdetect significant cancer, and you end up with thousands of patients whose disease is missed until it’s advanced, or who are aggressively treated when they didn’t need to be and are now dealing with incontinence or erectile dysfunction.

An original investigation[ii] published in November, 2023 by JAMA starts by acknowledging the misperception within the field of urology that MRI remains costly, despite the fact that MRI and MRI-targeted prostate biopsy have enhanced the accurate detection of clinically significant PCa. For their analysis, the authors projected 10-year diagnosis rates of significant PCa for a hypothetical population of 65-year-old U.S. men stratified according to 4 different PSA screening results:

  • PSA less than 2.5 ng/mL
  • PSA 2.5-4.0 ng/mL
  • PSA 4.1-10.0 ng/mL
  • PSA greater than 10.0 ng/mL.

They discovered that for the first three strata, “the MRI and potential MRI-guided biopsy strategy was cost-effective compared with standard [TRUS] biopsy.”

The value of this type of economic analysis lends objectivity to the improved benefits of MRI for diagnosing the kind of PCa that needs immediate treatment decisions. It is not a matter of opinion that MRI has revolutionized the detection and diagnosis of PCa. Demonstrating that over time it saves healthcare dollars compared with the traditional model of moving to TRUS biopsy following a suspicious PSA. While the use of ultrasound may be perceived as cheaper and more accessible than prostate MRI and in-bore MRI guided targeted biopsy, this assumption overlooks the mounting hidden costs of money and patient quality of life attached to things like biopsy side effects that require attention, repeat biopsy, overtreatment of insignificant PCa, cumulative costs of treatment side effects, etc.

The starting point for dealing with PCa must be precision detection, diagnosis, disease characterization through genomics, and other biomarkers. TRUS biopsy, with its inherent risks, is not cost-effective because it is simply inadequate to the task. Its true costs mount up over time. Kudos to the authors of the JAMA article for pointing doctors in the right clinical as well as economic direction.

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.

[i] Thompson IM, Pauler DK, Goodman PJ, Tangen CM et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med. 2004 May 27;350(22):2239-46. [ii] Yun H, Kim J, Gandhe A, et al. Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results. JAMA Netw Open. 2023;6(11):e2344856.


About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.

You may also be interested in...

WordPress Image Lightbox