Impact of Prebiopsy Multiparametric Magnetic Resonance Imaging on Prostate Cancer Detection in Switzerland

Background and objective: Multiparametric magnetic resonance imaging (mpMRI)-guided prostate biopsies have become the standard of care. This study aims to analyze changes in the distribution of detected prostate cancer (PCa) risk groups in Switzerland during the adoption period of a multiparametric magnetic resonance imaging (mpMRI)-guided prostate biopsy. Methods: This ecological study analyzed prostate biopsies from a tertiary hospital and PCa diagnoses from the National Agency for Cancer Registration in Switzerland between January 2005 and December 2019. A survey assessed mpMRI uptake in Swiss urological centers. PCa risk group proportions were calculated and compared for the entire period and annually. Key findings and limitations: A total of 4890 biopsies in the hospital dataset and 74 747 national PCa cases were analyzed. Before mpMRI availability, 72.6% of hospital biopsies were PCa negative, with detected cases including 46.4% low risk (LR), 30.5% intermediate risk (IR), and 23.2% high risk (HR). After the availability of mpMRI, 45.7% were PCa negative, with 24.6% LR, 49.0% IR, and 26.5% HR. National mpMRI uptake began in 2008, surpassing 95% by 2019. In 2005, 3448 PCa cases were recorded across 14 cantons, with 46.3% LR, 33.1% IR, and 20.6% HR. By 2019, 6868 cases were registered in 23 cantons, with 28.0% LR, 48.9% IR, and 23.2% HR. Conclusions and clinical implications: After implementation of mpMRI, fewer negative prostate biopsy results were observed. Furthermore, a shift was detected in the distribution of risk groups, with an increase in the proportion of IR cases and a decline in LR cases alongside the uptake of mpMRI. The proportion of HR cases remained essentially constant over time. Further research is needed to determine whether this reflects improved stratification or an artifact of the changed diagnostic pathway. Patient summary: In this study, we examined how the detected prostate cancer grades changed during the adoption of multiparametric magnetic resonance imaging (mpMRI)-guided prostate biopsies in Switzerland between 2005 and 2019. After mpMRI, fewer negative biopsies occurred and the distribution of prostate cancer grades changed, with more intermediate-risk and fewer low-risk cancers identified, while high-risk cases remained stable.