The benefit of personalized MRI in prostate cancerdetection and cost-effectiveness compared to multiparametricmri in prostate cancer screening

In our study, it was aimed to compare the diagnostic performances and cost-effectiveness of biparametric MRI (bpMRI) and multiparametric MRI (mpMRI) in prostate cancer imaging, and to evaluate the effectiveness of a personalized MRI protocol. In our study, 1004 patients who underwent mpMRI including diagnostically sufficient T2 and DWI sequences at Akdeniz University Faculty of Medicine Hospital between January 2017 and December 2023, and who had either stable PSA levels with at least 2 years of follow-up or biopsy results, were retrospectively evaluated. The patients were assessed as bpMRI and mpMRI by two separate experienced teams and scored according to PI-RADS v2.1. In addition, the patients' age, PSA, free PSA, prostate volume, PSA density, and histopathological findings were retrieved from the hospital archive system and recorded. In our study, it was observed that the bpMRI evaluation, which included sequences of sufficient diagnostic quality, was in full agreement with mpMRI for PI-RADS 1, 2, and 5 score groups. In the evaluations, 27 patients who were assessed as PI-RADS 3 on bpMRI were upgraded to PI-RADS 4 with mpMRI evaluation, and in this upgraded group, the rate of clinically significant prostate cancer (csPCa) was found to be 27.8% based on biopsy results. In the analyses performed, the number of mpMRIs needed to diagnose one additional malignancy (NNS) was calculated as 21.3. The main difference between the two imaging protocols was the approximately 3.2-fold cost difference caused by the contrast agent. Additionally, due to the time advantage of bpMRI, our projections showed that an additional 272 patients could be screened annually. Our study demonstrates that applying mpMRI to all patients in daily practice is unnecessary, and that a personalized MRI protocol—consisting of initially performing bpMRI and applying mpMRI only to cases evaluated as PI-RADS 3 on bpMRI to determine the final score—provides optimization without causing diagnostic loss. This approach, based on the data from our center, reduces unnecessary contrast use by 87.3%, shortens examination duration and the interval between appointment dates, and provides an annual saving of 28,522 USD. For the standardization of this approach, there is a need for practices that will enhance quality management of imaging parameters, the inclusion of additional parameters in patient management to prevent unnecessary biopsies, and larger-scale multicenter studies for personalized MRI.