Increasing and more consistent use of pre-biopsy MRI in prostate cancer diagnosis: insights from a population-based study in the Netherlands.

objectiveGuidelines 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

methodsMen 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.

resultsPre-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).

conclusionsPre-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.