A Cost-Benefit Comparison of Biparametric Magnetic Resonance Imaging Versus Conventional Prostate Cancer Screening

Purpose: : This study aimed to compare the cost-effectiveness and feasibility of biparametric magnetic resonance imaging (bp MRI) for prostate cancer screening to prostate-specific antigen (PSA)-based screening.Materials and Methods: We retrospectively reviewed the data from 602 men who had PSA-based prostate cancer screening between July 2014 and April 2017 and 621 men who underwent bp MRI-based prostate cancer screening between May 2017 and December 2020. Of them, 467 men with Prostate Imaging Reporting and Data System scores of 3 or higher underwent magnetic resonance imaging/ultrasound fusion transrectal biopsy and random transrectal prostate biopsy. The remaining 154 patients underwent random prostate biopsies only. Patient demographics, digital rectal examination, staging, PSA level, PSA density, bp MRI findings associated with prostate cancer detection on biopsy, admission rate for complications after prostate biopsy, and associated medical costs were analyzed.Results: Prebiopsy demographics were comparable. The MRI-based screening had a higher prostate cancer detection rate (62.7%) than conventional screening (45.1%). Biparametric MRI was more sensitive for clinically significant prostate cancer (csPCa) (40.6% vs. 23.5%). In 154 men who lacked a targetable prostate lesion, 47 and 14 patients (9.1%) had insignificant and significant prostate cancer, respectively. None of the patients had more than Gleason 8 (4+4). MRI-based screening costs more than conventional screening. However, the cost of detecting csPCa can be reduced by 49.4% (United States dollar [USD] 14,883.5 vs. USD 7,355.0).Conclusions: MRI-based screening is sensitive for csPCa and is cost-effective. It can also reduce unnecessary biopsies to detect insignificant prostate cancer