Prostate mpMRI in the UK: the state of the nation

The diagnosis of prostate cancer has changed. Improved magnetic resonance imaging (MRI) technology with diffusion-weighted imaging has led to the use of multiparametric MRI (mpMRI) before biopsy in patients suspected of having prostate cancer. This has the advantage that patients with a negative mpMRI may not need biopsy, therefore avoiding the risk of complications. Those in whom mpMRI is positive can have targeted biopsies with a higher probability of diagnosing clinically significant cancer. Prostate Cancer UK (PCUK) and the British Society of Urogenital Radiology submitted a Freedom of Information (FOI) request in 2016 to UK health areas in order to assess the use of mpMRI before biopsy as part of the initial diagnosis pathway. Another request was submitted by PCUK in 2018 to assess the progress made in the UK between these two dates. Both requests had the secondary aim of identifying barriers to the implementation of mpMRI. The FOI requests showed an increase in the use of mpMRI before biopsy with 59% of areas reporting improvement between the two requests. There has been a reduction in the percentage of areas not providing any form of pre-biopsy MRI from 25% in 2016 to 13% in 2018. There remains, however, geographical variation in implementation across the UK nations. Imaging practice also shows variation with some areas performing scans without dynamic contrast enhancement (DCE) and using the findings to guide referral decisions for biopsy. Eligibility criteria for pre-biopsy MRI also vary leading to some restrictive practices. Reported barriers to implementation included scanner capacity and staffing levels. Recent guidelines and recommendations by the National Institute for Health and Care Excellence (NICE) and NHS England for men aged 50-69 years with a prostate-specific antigen (PSA) level between >3 and <30 ng/ml to receive mpMRI before biopsy put further pressure on already understaffed and under-resourced radiology departments.