Background: On 1 July 2018, the Australian Medicare Benefits Schedule (MBS) introduced rebates for multi-parametric magnetic resonance imaging (mpMRI) for prostate cancer (PCa) workup. This study aimed to determine if mpMRI subsidisation before transperineal biopsy affected biopsy practice patterns and outcomes at an Australian tertiary institution.
Methods: The study identified patients who underwent transperineal prostate biopsy from 1 January 2017 to 1 January 2020, excluding those with known PCa. Patients were divided into two groups: pre-subsidisation (before 1 July 2018) and post-subsidisation (after 1 July 2018). Histopathological results were compared, and clinically significant cancer was defined as ISUP Grade Group ≥2.
Results: A total of 650 men met the inclusion criteria, with 361 in the pre-subsidisation cohort and 289 in the post-subsidisation cohort. Pre-biopsy mpMRI usage increased from 36.3% in the pre-subsidisation group to 77.5% in the post-subsidisation group. Positive biopsy rates were 59.6% pre-subsidisation and 68.2% post-subsidisation (p=0.024). The rate of clinically significant PCa increased from 39.1% pre-subsidisation to 49.5% post-subsidisation (p=0.008). The negative predictive value of mpMRI for clinically significant PCa was 86.5%.
Conclusion: Following the introduction of mpMRI subsidisation, there was a reduction in negative prostate biopsies and an increase in clinically significant PCa detection at the institution.
