Magnetic Resonance Imaging (MRI) for prostate cancer diagnosis in primary care

Background: Detection of prostate cancer in primary care relies on Digital Rectal Examination (DRE) and Prostate Specific Antigen (PSA), both of which have significant limitations. Magnetic Resonance Imaging (MRI) has emerged as a diagnostic test for prostate cancer that is more accurate than existing tests but is currently only used in secondary care. This PhD aimed to examine the potential impact of prostate MRI on the diagnosis of prostate cancer in primary care. Methods: I performed systematic reviews with narrative syntheses to examine the evidence on patient centred outcomes (PCOs) from diagnostic tests for prostate cancer, including MRI, and the cost-effectiveness of prostate cancer diagnostic pathways that incorporate pre-biopsy MRI. I undertook a qualitative study employing one-to-one interviews of patients who had undergone prostate MRI and GPs who had recently referred men with suspected prostate cancer for diagnostic testing to explore the acceptability of prostate MRI as a diagnostic test and experiences of the prostate cancer diagnostic pathway. I completed an early economic evaluation of primary care prostate cancer diagnostic pathways incorporating prostate MRI using decision analytic modelling informed by a linked data approach. Results: Prostate MRI and MRI-guided biopsy have more favourable PCOs compared to standard prostate biopsy techniques. Prostate MRI met most key constructs of acceptability for patients, whilst GPs had a spectrum of knowledge and understanding of prostate MRI as a diagnostic test for prostate cancer. Published evidence suggests MRI-based prostate cancer diagnostic pathways are cost-effective, although no studies incorporated primary care data. Modelling suggests implementing prostate MRI in primary care could reduce costs involved with prostate cancer diagnosis, without a significant utility detriment for patients. Conclusion: Incorporating MRI into primary care as a diagnostic test for prostate cancer could reduce costs for the NHS and is acceptable to patients. Prior to implementation in primary care, feasibility, comparable diagnostic accuracy, GPs' clinical knowledge, and improved outcomes for patients must be demonstrated.