ArticleProstate cancer and prostatic diseases2026
A nationwide histopathology study reflecting the impact of the introduction of MRI in the diagnostic trajectory of prostate cancer in routine clinical care.
Article in Prostate cancer and prostatic diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMagnetic resonance imaging (MRI), introduced into European (2019) and Dutch (2020) guidelines, reshaped prostate cancer (PCa) diagnostics by altering biopsy indications and strategies. In expert-center studies MRI-based diagnostics reduces biopsy rates and ISUP Grade Group (GG) 1 detection, while maintaining or increasing GG ≥ 2 detection compared to systematic biopsies. We evaluated nationwide biopsy outcomes during MRI adoption in routine practice in the Netherlands.
methodsRetrospective nationwide study of histopathology reports from all diagnostic biopsies in men without prior PCa in the Netherlands (2015-2021), retrieved from the Dutch nationwide pathology databank (Palga). Outcomes included annual biopsy volumes and proportions cancer-negative, GG1 and GG ≥ 2 biopsies. MRI-related terminology served as a proxy for MRI use. ISUP GG concordance between biopsy and radical prostatectomy (RP), defined as identical highest GG in biopsy and RP specimen, was assessed. The Mann-Kendall test evaluated monotonic time trends.
resultsAmong 127,856 biopsies (116,711 men), annual diagnostic biopsy numbers decreased from 18,719 (2015) to 17,094 (2021; -8.7%, p = 0.13). Cancer-negative biopsies declined from 49% to 29% (p = 0.003), while GG ≥ 2 detection increased from 30% to 53% (p = 0.002). GG1 detection minimally decreased (20% to 18%, p = 0.02). MRI terminology in pathology reports increased (8.2% to 51%) and biopsy-RP GG concordance improved (51% to 60%, p = 0.007). Analyses could not adjust for increased opportunistic PSA screening or adjunct diagnostic tool use.
conclusionsNationwide Dutch pathology data show improved diagnostic efficiency and efficacy over time, with fewer biopsies, fewer cancer-negative biopsies, and increased GG ≥ 2 detection. These findings coincide with rising estimated MRI uptake, suggesting MRI-driven diagnostic improvements.
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