Adding MRI Improves Cost-Effectiveness of Prostate Cancer Active Surveillance

In men who have prostate cancer, pairing active surveillance with prostate MRI is a more cost-effective approach to treatment over time than relying on active surveillance, repeated biopsy and prostate-specific antigen (PSA) tests.

These findings, published July 14 in Radiology, come on the heels of additional research that indicates prostate MRI can cut over-diagnosis in half when used for screening. In this new study, investigators from New York University Grossman School of Medicine look at the cost associated with various surveillance strategies, as well as the associated life expectancy.

Related Content: MRI Cuts Prostate Cancer Screening Over-Diagnosis by Half

“Globally the use of prostate MRI during active surveillance is increasing, and yet there are no consistent guidelines about its impact on clinical care, and how exactly clinicians can use the test during active surveillance,” said lead author Stella Kang, M.D., associate professor of radiology and population health. “Our research shows that MRI is a cost-effective tool for men and their clinicians to use to guide their management.”

According to the National Cancer Institute, roughly 248,000 men will receive prostate cancer diagnosis in 2021. Most disease will be found in the early stages, making it important to find a surveillance strategy that can closely monitor disease progression while minimizing discomfort and cost to the patient.

For their study, Kang’s team created a mathematical model that projected the cost-effectiveness of four prostate cancer surveillance strategies:

• Watchful waiting
• Active surveillance with PSA and repeated annual biopsy regardless of PSA results
• Active surveillance with PSA to determine need for MRI and biopsy
• Active surveillance with PSA test and MRI, using different thresholds of PI-RADS to determine biopsy need

According to their analysis, the team discovered that all strategies that included MRI offered better quality of life and life expectancy than those without the imaging. From a cost-effectiveness perspective, men who took part in active surveillance strategies with annual MRI saw the highest quality-adjusted life-years of 16.19. Those who underwent active surveillance with no MRI saw 16.14 years, and watchful waiting patients experienced 15.94 quality-adjusted life years.

Specifically, the team determined that the highest economic value was associated with annual MRI and a PI-RADS score of 4 or greater that led to a biopsy. This led to 42-percent fewer biopsies over a lifetime compared with the same strategy using a PI-RADS score of 3 or greater.

Ultimately, the team said, these findings should open up more surveillance options for men and give them an opportunity for a more robust conversation about management strategies with their providers.

“These findings are very important, especially given the high prevalence of prostate cancer and expanding use of active surveillance,” said senior author Stacy Loeb, M.D., MSc, Ph.D., professor of urology and population health from NYU Langone Health. “There is currently no consensus over the optimal monitoring protocol during active surveillance. These results suggest that MRI can help to reduce the total number of serial biopsies, while preserving quality of life. These results can help patients and physicians to explore the trade-offs involved in different monitoring approaches.”

The team did note, though, that further research is needed as these findings do not account for all patient ages, co-morbid conditions, and misclassification of cancers.

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