Target Acquired: Analysis of Pre-Biopsy MRI and Cancer Detection Rates in a Single Academic Center before and after the Publication of the PRECISION Trial
Adam Wiggins, MD1, Molly Parries, BS2, Tasneem Zaihra Rizvi, PhD1, William Faust, MD1.
1Lahey Hospital and Medical Center, Burlington, MA, USA, 2Tufts University School of Medicine, Boston, MA, USA.
BACKGROUND: Pre-biopsy MRI has become more accepted in prostate cancer diagnosis since, among other factors, the 2018 PRECISION Trial publication. Few studies exist looking at this trial's impact on real-world clinical practice. We sought to evaluate the changes over time in our academic clinical practice with regards to MRI use, patient characteristics and cancer detection rates for biopsy naïve patients before and after publication of this trial.
METHODS: Biopsy-naïve patients between 04/2015 and 01/2022 were categorized as either "Pre-" or "Post-" PRECISION Trial publication (Pre-PT and Post-PT, respectively). Baseline characteristics were analyzed. Cancer Detection Rate (CDR), clinically significant cancer (csPCa, defined as >/= Grade Group Two disease), and clinically insignificant cancer (ciPCa) rates were calculated. Odds ratios (OR) for CDR in the Pre- vs Post-PT data sets were calculated using logistic regression models, with adjustment for confounding variables.
RESULTS: 1,436 men were included in the analysis, 815 in the Post-PT cohort and 621 in the Pre-PT cohort. More men underwent pre-biopsy MRI after the PRECISION trial (46.2% vs 16.5%, respectively, P < 0.001). Comparing Post-PT to Pre-PT cohorts, median age was 64.8 vs 63.3 years (P = 0.001), median PSA was 6.3ng/ml vs 5.8ng/ml (P = 0.003) and an abnormal digital rectal exam was found in 40.6 vs 31.9% (P < 0.001) of men. There were no differences in race (P = 0.313) or family history of prostate cancer (P = 0.186). The CDR was higher in the post-PT cohort (65.3% vs 45.7%, P < 0.001). More clinically significant PCa was found (43.9% vs 31.8%, P < 0.001) while the CDR of clinically insignificant PCa remained unchanged (32.8% vs 30.4%, P < 0.488). On multivariate logistic regression, the post-PT period was independently associated with csCDR (OR 1.42, CI 1.10 - 1.83, p = 0.007).
CONCLUSIONS: Since the PRECISION trial publication, more men have undergone prebiopsy MRI and more csPCa has been detected with no change in ciPCa in our institution. While there are certainly other contributing factors that may be at play, our study outlines a clinical transition towards more widespread utilization of pre-biopsy MRI, while detailing changes in patient demographics, and demonstrating an improvement in CDR since the PRECISION trial publication. 
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