MRI has shown benefits over the conventional prostate biopsy strategy of systematic transrectal ultrasound, including finding more cancers, reducing overdiagnosis, and reducing unnecessary biopsies, a team led by Dr. Maarten de Rooij, PhD, wrote in the study abstract.
But how to proceed after a suspicious prostate MRI -- that is, whether to combine MRI with transrectal ultrasound or whether the ultrasound can be eliminated altogether -- has remained unclear. Therefore, De Rooij's group sought to evaluate the cost-effectiveness of MRI-directed biopsy strategies compared with using transrectal ultrasound without prior MRI.
The study consisted of a decision analytic model based on an 18-year time frame in men who had not undergone biopsy but were suspected of having prostate cancer. The group compared the following strategies:
- Transrectal ultrasound (TRUS) guided biopsies in all men, without prior MRI
- MR-targeted biopsies only in case of suspicious MRI
- MR-targeted and TRUS-guided biopsy in case of suspicious MRI
- MR-targeted and TRUS-guided biopsy in case of suspicious MRI and TRUS-guided biopsy after negative MRI
A strategy was considered cost-effective if the cost of gaining one quality-adjusted life year did not exceed $23,000.
The team found that although all the MRI strategies were more cost-effective than the conventional TRUS-guided biopsy strategy, the strategy of performing both MR-targeted and TRUS-guided biopsy after suspicious MRI was the most cost-effective.
"The outcomes of this cost-effectiveness study are helpful for policymakers and clinicians, to guide a decision about the best biopsy strategy in men suspected of prostate cancer," the team concluded.