Utilisation of MRI in Newly Diagnosed Prostate Cancer in Aotearoa New Zealand

Abstract

Background

The burden of prostate cancer (PCa) continues to increase in New Zealand, and remains the only solid organ cancer diagnosed by non-targeted biopsy. International guidelines have changed, making MRI routine given the unequivocal evidence of increased diagnostic accuracy. In Aotearoa, MRI has not been standardised in the diagnostic pathway, and there is anecdotal evidence of geographical variation in its use.

Methods

This was a retrospective cohort study aimed to examine the prevalence, trend, and health equity in the use of MRI prostate in the diagnosis of PCa, and investigate the effect of MRI on the accuracy in diagnosing clinically significant PCa in New Zealand. Data was obtained from the PCa Outcomes Registry New Zealand between January 2016 and June 2022.

Results

13 983 men (1155 Māori) were included (mean age of 67.6). Men who were diagnosed in the private sector were 3.6 times (OR: 95% CI: 3.0, 4.5) more likely to receive pre-biopsy MRI compared to those diagnosed in the public system. In the non-Māori group, those living in urban areas were more likely to receive pre-biopsy MRI than those living in rural areas (χ² = 39.8; p < 0.001). There was a strong pre-biopsy MRI scan effect on the odds of detecting low-risk and higher grade PCa.

Conclusions

There are clear inequities in the access to pre-biopsy MRI between the public and private sectors, and in between the regions in Aotearoa. We need to identify and overcome the barriers in implementing standardised access to this invaluable diagnostic resource.