Evaluating the efficacy of a low-cost cognitive MRI-targeted prostate biopsy protocol: is there still a role for lower volume centers in the Prostate Imaging Reporting and Data System (PI-RADS) version 2 era?

Purpose MRI-targeted biopsy has improved prostate biopsy yield. However, cost constraints have made it difficult for many institutions to implement the newer methods. We evaluated the performance of a low-cost cognitive-targeting biopsy protocol based on 1.5 T multiparametric MRI graded with Prostate Imaging Reporting and Data System (PI-RADS) version 2 to examine the role for these institutions moving forward. Methods Retrospective analysis of 251 consecutive patients with prostate-specific antigen (PSA) under 50 who underwent MRI and subsequent prostate biopsy at a single facility. In addition to systematic biopsy, targeted cores were obtained with cognitive recognition under ultrasound. A control group of 267 consecutive patients with PSA under 50 biopsied without prior MRI was analyzed. Results Prostate biopsy preceded by MRI had a significantly higher probability of detecting both prostate cancer (68.1% vs. 51.3%) and clinically significant prostate cancer (57.4% vs. 39.7%) ( p values