1. Do you routinely conduct prostate MRI (bpMRI/mpMRI) scans before first prostate biopsy as part of the initial diagnostic process? (please tick all that apply):
a. Yes, using T2-weighted, diffusion-weighted (multi-b ADC and high/long b) and dynamic contrast enhanced (DCE) sequences
b. Yes, using T2-weighted, diffusion-weighted (multi-b ADC and high/long b) sequences but not DCE
c. No but we refer to another provider (please provide details)
d. No (please provide details)
ANSWER - A
2. If yes, to 1a: What percentage of men with suspected prostate cancer receive mpMRI before biopsy as part of the initial diagnostic process?
ANSWER - 100% of the ones which would be suitable for radical treatment
3. If yes, to 1b: What percentage of men with suspected prostate cancer receive bpMRI before biopsy as part of the initial diagnostic process?
ANSWER - N/A
4. What are your eligibility criteria/exclusion criteria for prostate MRI? (please tick all that apply):
a. Age (please provide details)
b. Symptoms (please provide details)
c. Life expectancy (please provide details)
d. Contra-indications (please provide details)
e. Other (please provide details)
ANSWER - E - If suitable for radical treatment
5. Are you using results from the prostate MRI before biopsy to rule some men out of biopsy as part of the initial diagnostic process? (yes/no)
ANSWER - YES, however rule out is not an appropriate term. If the PSA is >10 (or pre-test risk >25% using a calculator – they roughly equate to the same thing) or the PSA continues to rise, even if MRI is normal, we may still perform a biopsy.
6. Do you biopsy all PI-RADS or LIKERT 3 scores?
a. Yes
b. No
c. Dependent on patient histology
ANSWER - B - We advise patients to have biopsy but they often refuse so we then offer PSA monitoring
7. What threshold do you mostly use for ruling men out of biopsy?
a. PI-RADs 3 and above
b. LIKERT 3 and above
c. PI-RADs 4 and above
d. LIKERT 4 and above
e. Varies depending on age (Please provide detail)
f. Varies depending on other factors (Please provide detail)
ANSWER - We don’t perform a biopsy if the PI-RADS/LIKERT (we use the terms interchangeably, essentially we mean LIKERT) is BELOW 3 AND the pre-test risk <25%/PSA<10.
8. What percentage of men do you estimate are ruled out of biopsy?
ANSWER - We are currently undertaking an audit on this.
9. Have there been any changes to your prostate MRI capacity in the last year? (please choose all that apply):
a. An additional or new MRI scanner
b. Increased MRI scanner slots for prostate
c. Agreement to use Dynamic Contrast Enhancement
d. No longer using Dynamic Contrast Enhancement
e. A scanner/magnet upgrade
f. other (free text)
ANSWER - We roughly levelled out the number of prostate MRIs we were doing about 2-3 years ago, just before we started the pre-biopsy MRI. Doing pre-biopsy MRI hasn’t obviously changed the number of scans we have done.
10. Has the number of radiologists at your trust/health board who report prostate MRI scans changed in the last year?
a. Increased
b. Decreased
c. Stayed the same
ANSWER - C
11. How many radiologists at your trust/health board report at least 250 prostate MRI scans per year?
ANSWER - 2
12. Which of the following processes do you follow to manage men ruled out of an immediate biopsy, but with a raised PSA?
a. NICE Guidelines: prostate cancer diagnosis and management (NG131) b. A local protocol (please provide details) c. Other (please provide details) ANSWER C = PSA follow-up