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Updated: May 29, 2026
Use of Magnetic Resonance Imaging and Biopsy Data to Guide Sampling Procedures for Prostate Cancer Biobanking
Published on: October 10, 2019
Increasing and more consistent use of pre-biopsy MRI in prostate cancer diagnosis: insights from a population-based
C C Loeff1,2, I G Schoots3,4, P J van Leeuwen5
1Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands. c.loeff@iknl.nl.
Objective:
Guidelines recommend MRI before prostate biopsy in men with suspected prostate cancer (PCa). However, real-world data on clinical use are scarce. This study aims to provide comprehensive insight into the nationwide use of pre-biopsy MRI across the Netherlands.
Materials And Methods:
Men with biopsy-proven primary PCa diagnosed between 2019 and 2023, were identified through the Netherlands Cancer Registry (main cohort; n = 50,987). A historical cohort included similar cases from 2015 to 2016 (n = 5183). Four MRI-related periods were defined: historical (2015-2016), pre-implementation (2019), implementation (2020), and post-implementation (2021-2023). Mixed-effects logistic regression analyses assessed factors associated with pre-biopsy MRI use and heterogeneity across periods. Inter-hospital variation was quantified using case-mix (age, PSA, clinical disease stage) adjusted hospital-specific probabilities.
Results:
Pre-biopsy MRI use increased from 17 to 74% between 2015 and 2023. Across all periods (main cohort), men over 70 and those with a PSA > 50 µg/L or cT3-4 disease were significantly less likely to undergo pre-biopsy MRI than younger men, those with PSA < 10 µg/L, or cT1 disease, respectively. Heterogeneity in effect size across periods was observed for all factors except age. Inter-hospital variation was present in all MRI-related periods, although it significantly decreased over time. Estimated 75% midrange rates varied from 9.7-86% (pre-implementation) to 62-88% (post-implementation).
Conclusions:
Pre-biopsy MRI use in PCa diagnosis has markedly increased and has become more consistent across hospitals. Over time, its use became more targeted, focusing on patients without signs of advanced disease, in accordance with EAU guidelines recommendations. Continued efforts to standardize MRI use may improve equity and optimize patient outcomes.
Critical Relevance Statement:
This study evaluates the nationwide implementation of pre-biopsy MRI in PCa diagnosis, revealing increased and more targeted use, demonstrating consistency across hospitals, and providing insights to guide standardization and optimize patient outcomes.
Key Points:
Comprehensive population-level data on the uptake of pre-biopsy MRI after implementing guideline recommendations are essential for clinical practice evaluations on a national level. In the Netherlands, these data show an increase in the uptake of pre-biopsy MRI over time, demonstrate consistent patterns across hospitals, and illustrate a shift towards use in patients without advanced disease, aligning with EAU guidelines recommendations. Ongoing efforts to implement and standardize pre-biopsy MRI use in routine clinical practice are critical to promote equity and optimize patient outcomes on a population-based level.
Insights
Pre-biopsy MRI use for prostate cancer (PCa) diagnosis significantly increased nationwide, becoming more targeted towards patients without advanced disease. This trend aligns with guidelines and shows improved consistency across hospitals, enhancing equity and outcomes.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Guidelines recommend MRI before prostate biopsy for suspected prostate cancer (PCa).
- Real-world data on the clinical implementation of pre-biopsy MRI are limited.
- This study provides nationwide insights into pre-biopsy MRI use in the Netherlands.
Purpose of the Study:
- To assess the nationwide adoption and patterns of pre-biopsy MRI use in PCa diagnosis.
- To evaluate changes in MRI utilization across different time periods and patient groups.
- To analyze inter-hospital variations in pre-biopsy MRI implementation.
Main Methods:
- Analysis of a nationwide cohort of men with biopsy-proven primary PCa (2019-2023) and a historical cohort (2015-2016).
- Defined four MRI-related periods: historical, pre-implementation, implementation, and post-implementation.
- Used mixed-effects logistic regression to identify factors associated with MRI use and assessed inter-hospital variation.
Main Results:
- Pre-biopsy MRI use surged from 17% (2015) to 74% (2023).
- MRI use was less common in older men (>70) and those with advanced disease (PSA >50 µg/L or cT3-4).
- Inter-hospital variation in MRI use decreased over time, with improved consistency post-implementation.
Conclusions:
- Pre-biopsy MRI use for PCa diagnosis has markedly increased and become more standardized across hospitals.
- Utilization is increasingly targeted towards patients without signs of advanced disease, aligning with EAU guidelines.
- Standardizing MRI use is crucial for improving equity and optimizing patient outcomes.
