Prostate MRI: a national survey of Urologist’s attitudes and perceptions

ABSTRACT Introduction The use of multi-parametric (MP) MRI to diagnose prostate cancer has been the subject of intense research, with many studies showing positive results. The purpose of our study is to better understand the accessibility, role, and perceived accuracy of MP-MRI in practice by surveying practicing urologists. Materials and Methods Surveys were sent to 7,400 practicing American Urological Association member physicians with a current email address. The survey asked demographic information and addressed access, accuracy, cost, and role of prostate MRI in clinical practice. Results Our survey elicited 276 responses. Respondents felt that limited access and prohibitive cost of MP-MRI limits its use, 72% and 59% respectively. Academic urologists ordered more MP-MRI studies per year than those in private practice (43.3% vs. 21.1%; p<0.001). Urologists who performed more than 30 prostatectomies a year were more likely to feel that an MP-MRI would change their surgical approach (37.5% vs. 19.6%, p-value=0.002). Only 25% of respondents agreed or strongly agreed that MP-MRI should be used in active surveillance. For patients with negative biopsies and elevated PSA, 39% reported MP-MRI to be very useful. Conclusions Our study found that MP-MRI use is most prominent among practitioners who are oncology fellowship-trained, practice at academic centers, and perform more than 30 prostatectomies per year. Limited access and prohibitive cost of MP-MRI may limit its utility in practice. Additionally, study participants perceive a lack of accuracy of MP-MRI, which is contrary to the recent literature.

摘要
引言 多参数磁共振成像（multi-parametric MRI，MP-MRI）用于前列腺癌诊断的相关研究一直是学界热点方向，多项研究均取得了积极成果。本研究旨在通过对执业泌尿外科医师开展问卷调查，深入明晰临床实践中MP-MRI的可及性、应用价值及临床认可度。
材料与方法 本研究向7400名留存有效电子邮箱的美国泌尿外科协会（American Urological Association，AUA）注册执业医师发送了调查问卷。问卷内容涵盖人口统计学信息，同时围绕前列腺MRI在临床实践中的可及性、准确性、应用成本及角色定位等维度进行设计。
结果 本次调查共回收有效问卷276份。结果显示，受调查医师普遍认为MP-MRI的可及性不足与高昂成本是制约其临床应用的主要因素，分别有72%与59%的受访者持该观点。学术型泌尿外科医师每年开具的MP-MRI检查量高于私立诊所医师（43.3% vs. 21.1%；p<0.001）。每年开展30台以上前列腺切除术的医师，更倾向于认为MP-MRI会改变其手术方案（37.5% vs. 19.6%，p值=0.002）。仅25%的受访者同意或完全同意将MP-MRI应用于前列腺癌主动监测流程。对于活检结果呈阴性但前列腺特异性抗原（Prostate Specific Antigen，PSA）水平升高的患者，39%的医师认为MP-MRI具有极高的临床应用价值。
结论 本研究发现，接受肿瘤学专科培训、在学术中心执业以及年前列腺切除术量超过30台的医师，对MP-MRI的应用率更高。MP-MRI的可及性不足与高昂成本或限制其临床推广价值。此外，本次研究参与者普遍认为MP-MRI的临床准确性有待提升，这与近期相关文献的报道相悖。