Multiparametric MRI in prostate cancer: diagnostic accuracy and economic evaluation

Abstract

Prostate cancer is the most common cancer among men. There are prostate tumours that will never cause symptoms and do not need active treatment, but there are also aggressive types where it is important to treat as quickly as possible. With the current detection technique – ultrasound guided prostate biopsy - it is difficult to distinguish between these two types of cancer. This causes tumours to be misclassified, leading to inadequate therapy, while on the other hand men with aggressive cancer are sometimes treated too late. Many studies show that by making an MRI in men suspected of prostate cancer, a better distinction can be made between men who need to be treated or not. In this thesis we give an overview of what is known in the current literature about the use of MRI in detecting and classifying prostate tumours. Also, we show that the use of MRI in men suspected of prostate cancer does not have to be more expensive than the current standard of care. Compared with the current diagnostic standard, over-treatment and over-diagnosis of non-aggressive prostate cancer can decrease drastically when using MRI (89%). In addition, the number of men who need to undergo ultrasound guided prostate biopsies can be reduced by almost half.