Factors Impacting Clinician Reluctance to Defer Prostate Biopsy in Men with Negative Magnetic Resonance Imaging

Abstract

Abstract Purpose: Multiparametric magnetic resonance imaging (mpMRI) enables clinicians to omit prostate biopsy in men with negative (Prostate Imaging-Reporting and Data System v2, PI-RADS ≤ 2) mpMRI. We evaluate one-year outcomes in clinically significant prostate cancer (csPCa) detection following recommendation to defer biopsy in men with negative mpMRI, and assess the relationship between factors influencing adherence to this recommendation and csPCa detection.Methods: Retrospective data including demographics and clinical characteristics were collected for patients who underwent cognitively-targeted transrectal ultrasound-guided biopsy at our institution over July 2017 -June 2020 (Pre-Medicare rebate, Post-Medicare/pre-recommendation and post-recommendation years respectively). Primary endpoint was to determine whether a unit recommendation to only perform biopsy in men with PI-RADS > 2 on mpMRI improved csPCa detection (International Society of Urological Pathology Grade Group, ISUP GG ≥ 2). Secondary endpoint was to assess factors influencing adherence to this recommendation.Results: 130 patients underwent biopsy over the period, with 19 on active surveillance. The recommendation was not adopted and therefore did not improve csPCa detection rate (41% vs 44% pre-recommendation). 52 men proceeded to biopsy despite negative mpMRI, a greater number than pre-recommendation (n = 35, 37%). Eight men with a negative mpMRI had csPCa, with two reporting high-grade disease (ISUP GG ≥ 4). On multivariable analysis, age, prostate-specific antigen, prostate volume, number of cores, abnormal digital rectal examination and family history were not associated with csPCa detection in men with negative mpMRI.Conclusion: The recommendation to defer biopsy in men with negative MRI was not adopted by clinicians. Although patient and clinical factors were commonly quoted reasons to biopsy, none were found to be accurate predictors of csPCa.