Increased magnetic resonance imaging in prostate cancer management—What are the outcomes?

• Published in: Journal of evaluation in clinical practice 2023-09, Vol.29 (6), p.893-902
• Main Authors: Hofmann, Bjørn, Haug, Erik Skaaheim, Andersen, Eivind Richter, Kjelle, Elin
• Format: Article
• Language: English
• Subjects: Clinical outcomes; Disease management; evaluation; health services research; Health surveillance; Magnetic resonance imaging; practical reasoning; Prostate cancer
• ISSN: 1356-1294; 1365-2753
• DOI: 10.1111/jep.13791

Rationale Increased attention to cancer care has instigated altered systems for screening, diagnosis, and management of various types of cancer, such as in the prostate. While such systems very likely have improved the quality of cancer care, they also result in the altered use of specific services, such as magnetic resonance imaging (MRI). Aims and Objective To study the change in the use of prostate MRI in the Norwegian health care system from 2013 to 2021 and to investigate some reasons for and potential implications of this change. Method Data from the Norwegian Health Economics Administration (HELFO), The Cancer Registry of Norway and Cause‐of‐death registry at the Norwegian Institute of public health and the health registry of Vestfold Hospital Trust were used for descriptive statistical analysis. Results The number of MRIs of the prostate increased threefold from 2013 to 2021, representing an extra cost of 2 million USD in 2020. The incidence of prostate cancer was stable at about 5000 cases per year, corresponding to 178 per 100,000 men, indicating no increased overdiagnosis. However, the clinical staging has changed substantially during this period, indicating stage and grade migration. The number of negative biopsies was reduced, and there are three MRIs per reduced negative biopsy. The number of persons on active surveillance increased during the period. However, these changes are partly independent of the increase in the number of MRIs. Conclusion There was a substantial increase in the number of prostate MRIs and thus an increase in costs. This appears to have contributed to the reduction of negative biopsies, improved staging and increased active surveillance. However, as these effects are partly independent of the increase in MRIs, we need to document the outcomes for patients from prostate MRIs as their opportunity costs are substantial.