title: Dramatic increase in the utilization of multiparametric magnetic resonance imaging for detection and management of prostate cancer.
abstract: Multiparametric MRI (mpMRI) of the prostate is an evolving technology that provides functional information of the prostate that helps distinguish benign from malignant lesions. We hypothesized that mpMRI is rapidly adopted in the US to fill the unmet need for a non-invasive, accurate screening tool. The aim of this study is to assess the increasing utilization of mpMRI for the diagnosis and management of prostate cancer.
  
  
  
  We conducted a retrospective review of an institutional clinical data repository of four million patients. Clinical information from all men undergoing mpMRI from October 2013 to December 2015 was collected in a prospectively designed database. Individual chart reviews were performed for each patient.
  
  
  
  1521 mpMRI of the prostate were performed with an increase in the use of 486% over 26 months. The most common indication for mpMRI was abnormal screening (64%) and 47% of these men went on to prostate biopsy, either by cognitive mapping (65%) or MRI-US fusion targeting (35%). 261 men elected to defer prostate needle biopsy after informative decision-making with their urologist. 12.7% of mpMRI were performed for active surveillance, 7.5% for clinical staging, and 3.2% by radiation oncologists planning radiotherapy. 7% of mpMRI were performed to evaluate the pelvis for biochemical recurrence, a third of which identified a region of suspicion for targeted.
  
  
  
  Prostate mpMRI is increasingly performed for both the diagnosis and management of prostate cancer. As clinical utilization increases along with the diffusion of technology and radiologic expertise, MpMRI has the potential to influence clinical decision-making and fulfill the need for a non-invasive, accurate tool for the diagnosis and management of prostate cancer.
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Daniel-oberlin@northwestern.edu.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Oberlin
authors.affiliation: Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: David D
authors.initials: DD
authors.lastname: Casalino
authors.affiliation: Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Meeks
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003657:Decision Making; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D014481:United States
keywords: Active surveillance; Mutliparametric magnetic resonance Imaging; Practice patterns; Prostate biopsy; Prostate cancer