Current Prostate Diagnostic Pathway Results Summary for Tairawhiti

267 men with PSA greater than 4 have had a pre-biopsy MRI on the hospital 1.5T scanner.
25.1% of these men had an MRI that suggests biopsy can be avoided and that continued PSA monitoring with possible followup MRI can be performed.

113 men with PSA greater than 3.5 have had a pre-biopsy MRI on the Mātai 3T scanner.
46.9% of these men had an an MRI that suggests biopsy can be avoided and that continued PSA monitoring with possible followup MRI can be performed.

76 men have had a biopsy using the transperineal biopsy system at the hospital which allows targeted biopsies of any suspicious findings seen on the pre-biopsy MRI.

75.0% of men undergoing biopsy received a diagnosis of significant prostate cancer. These men need to have a discussion with their urologist regarding additional tests such as CT or PSMA PET. Most of these cancers will require treatment. Some can be closely watched.

10.5% percent of men undergoing biopsy received a diagnosis of low grade prostate cancer. Only a small number of these cancers require treatment. Most of these low grade cancers can be followed and are not thought to be life threatening.

The decision to treat versus followup as well as the best way to treat is made based on conversations with the urologist.

Of the 58 moderately suspicious findings on MRI that were targeted for biopsy, 51.7% of these turned out to be a significant cancer. 19.0% of these turned out to be a low grade cancer.

Of the 38 highly suspicious findings on MRI that were targeted for biopsy, 78.9% of these turned out to be a significant cancer. 13.2% of these turned out to be a low grade cancer.

Only 6 significant cancers were detected away from suspicious MRI findings. This happened in 10.0% of men undergoing biopsy.

We think these number are pretty good. If the MRI finds something abnormal, there is a good chance it is cancer.
81.6% of the targeted biopsy results were felt to be concordant - meaning that even if the biopsy result is something other than cancer - the MRI appearance is still felt, even in retrospect, to have warranted a biopsy. We would like this number to be close to 100% - but there will always be findings on the MRI that look like cancer but are actually not cancer.
A good target for this number is 75%.

Summary

In summary, pre-biopsy MRI has allowed 31.6% of men being able to potentially defer biopsy. 85.5% of men undergoing biopsy were found to have prostate cancer. This suggests that the risk of a man with PSA over 3.5 having an unnecessary biopsy is low.

10.5% of men had low-grade prostate cancer. There is always the risk of over-treating these low-grade cancers so we would like to reduce the number of low-grade cancers that we detect.

With MRI and targeted biopsy after regular screening, we're minimising the intervention cascade after PSA tests. You can use the numbers on this web-page as a starting point for discussing if having a PSA test is right for you.