ESUI16: Role of MRI needs further validation

Thu, 24 Nov 2016 • Joel Vega

Emerging imaging technologies such as multi-parametric Magnetic Resonance Imaging (mpMRI) offer benefits but more empirical studies are needed to support quality assessments of emerging imaging procedures.

At the opening plenary session of the 5th EAU Section of Urological Imaging (ESUI16) held today in Milan, urology imaging experts discussed the pros and cons of new imaging tools compared to standard procedures such as transrectal ultrasound (TRUS) guided biopsies.

Nicolas Mottet (FR) argued in the Point-Counterpoint discussion that with regards to MRI, the cost is less of an issue compared to the question of optimal use. “The cost is not the real issue but rather the optimal quality,” said Mottet as he noted that if biopsy precedes MRI, the results will be sub-optimal.

He underscored that attention should instead focus on how to optimize the role of MRI vis-à-vis other tools such as risk calculators and acquiring PSA values.

Taking the counter-point view, Hashim Uddin Ahmed (GB) further expanded on the benefits of MRI as he noted that in most scenarios MRI is more effective and less expensive. He also mentioned that there is already a new pathway that underscores the use of MRI.

“MP-MRI prior to TRUS-biopsy can identify at least one quarter of men presenting with an elevated PSA who might safely avoid prostate biopsies,” said Ahmed. “MP-MRI followed by biopsy can reduce the over-diagnosis of clinically insignificant prostate cancer.”

Moreover, Ahmed said MP-MRI can identify over 90% of men with clinically significant prostate cancers. “AN MP-MRI strategy is clinically and cost-effective and should now be the new standard of care before a first biopsy,” added Ahmed.

ESUI chairman Jochen Walz (FR) however cautioned during the ensuing discussion that quality control assessments are needed to further validate the use of MRI.

“I think we are heading to MRI…but we should have a quality assurance first, “said Walz. “Quality control comes first before it can be established that MRI, indeed, has more benefits before biopsy,” reiterated Walz.