National survey of practice patterns employing MRI-guided prostate biopsy for diagnosis of prostate cancer.

Abstract

104 Background: Targeted MRI/Ultrasound (MR/US) guided biopsy is an emerging technology that has the potential to change standard of care for the diagnosis and management of prostate cancer. It is believed that this new technology is rapidly proliferating, however quantitative analysis to describe these trends is not available. The primary objective of this study was to assess nationwide urologist opinions and efforts to implement MR/US imaging into their prostate cancer practices. Methods: A questionnaire was generated and distributed using REDCap to 7341 practicing urologists within the United States. The twenty question survey was designed to gather information regarding demographics, current and recent changes in MRI use, opinions on targeted MR/US guided biopsy, and barriers to implementation. The survey results were then analyzed with ANOVA. Results: 291 practicing urologists completed the survey. Respondents were primarily trained in general urology (60%) or urologic oncology (22%) and well distributed across practice type and geographic location. 86% of respondents currently employ MRI in some capacity in their practice, and 60% report using MR/US guided biopsy. 67% of respondents report increased use of MR/US guided biopsy over the past 5 years and 81% believe it is appropriate to use MR/US guided biopsy for the diagnosis of prostate cancer. Academic centers had the greatest utilization of targeted biopsy (72%) and solo practitioners had the least (38%, p = 0.003). The northeast region also demonstrated greatest use of targeted biopsy (68%) and western region had the least (44%, p = 0.02). 24% of respondents feel there is sufficient evidence to employ MR/US as standard of care in all prostate biopsies, while 65% believe MR/US should be reserved for select cases such as men with prior negative biopsies. Of those not performing biopsies, 69% of respondents cited cost as a barrier to implementation. Conclusions: While there are some reservations about employing MR/US guided biopsy, the data suggests urologists support its use, and are making efforts to introduce targeted MR/US guided biopsy into their practice. Regional and practice setting variations exist in adaptation of this technology.