MRS and enhanced MRI in localisation of prostate abnormalities

Systematic review of the diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy

This project included a systematic review of studies to assess the diagnostic accuracy of MRS, DCE-MRI and DW-MRI for localising prostate abnormalities for biopsy in comparison with T2-MRI and/or TRUS (trans-rectal ultrasound)-guided biopsy. A Markov model was developed to assess the cost-effectiveness of using the alternative MRI/MRS sequences for directing TRUS-guided biopsies, compared with a systematic extended-cores TRUS-guided approach.

Outcome and Translation

This model-based evaluation of alternative diagnostic strategies yielded very small differences in QALYs. The evaluation of diagnostic strategies for prostate cancer is complicated by concerns about over-diagnosis and uncertainty surrounding the benefits of radical treatment for patients with low-/moderate-risk disease. If eMRI techniques can be confirmed to have high sensitivity for high-risk cancer, while negating the need for biopsies in patients with low-risk disease, they could offer a cost-effective approach to diagnosis. The results of the modelling undertaken for this study were considered in the update of the NICE guideline on diagnosis and management of prostate cancer: https://www.nice.org.uk/guidance/CG175  

NICE guideline CG175. Prostate cancer: diagnosis and treatment 

HERU researchers involved in this research project: Graham Scotland and Emma Tassie

External collaborators: G Mowatt, C Boachie, M Cruickshank, JA Ford, C Fraser, L Kurban, TB Lam, AR Padhani, J Royle (Aberdeen Health Technology Assessment Group) and TW Scheenen (Radboud University Nijmegen Medical Center)

Publications

Mowatt, G., Scotland, G. , Boachie, C., Cruickshank, M., Ford, J. A., Fraser, C., Kurban, L., Lam, T. B., Padhani, A. R., Royle, J., Scheenen, T. W. and Tassie, E. (2012) Systematic review of the diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy. Final grant report submitted to the NIHR HTA programme, Aberdeen: University of Aberdeen HTA Group.

Mowatt, G., Scotland, G., Boachie, C., Cruickshank, M., Ford, J.A., Fraser, C., Kurban, L., Lam, T.B., Padhani, A.R., Royle, J., Scheenen, T.W. and Tassie, E. (2013) 'Systematic review of the diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy', Health Technology Assessment, 17(20).

Presentations

Cruickshank, M., Mowatt, G., Scotland, G., Boachie, C., Ford, J., Fraser, C., Kurban, L., Lam, T., Padhani, A., Royle, J., Scheenen, T. and Tassie, E. (2012) 'Systematic review of the diagnostic accuracy of MRS and enhanced MRI techniques in aiding the localisation of prostate abnormalities for biopsy', Poster presentation, Improving Quality in Health Care: Translating Evidence into Practice, Edinburgh, November 2012.

Scotland, G., Tassie, E., Mowatt, G., Boachie, C., Cruickshank, M., Ford, J., Fraser, C., Kurban, L., Lam, T., Padhani, A., Royle, J. and Scheenen, T. (2013) 'Modelling the cost-effectiveness of using different MRI techniques to localise prostate abnormalities for biopsy in patients with a previous negative biopsy', Poster presentation, Methods for Evaluating Medical Tests and Biomarkers Symposium Birmingham, 15-16 July 2013.

Tassie, E., Mowatt, G., Boachie, C., Cruickshank, M., Ford, J., Fraser, C., Kurban, L., Lam, T., Padhani, A., Royle, J., Scheenen, T. and Scotland, G. (2013) 'Modelling the cost-effectiveness of using different MRI techniques to localise prostate abnormalities for biopsy in patients with previous negative biopsy: the challenge of identifying the optimal strategy' Health Technology Assessment International (HTAi). Seoul, South Korea, June 2013.