Perceptions of Prostate MRI and Fusion Biopsy of Radiation Oncologists and Urologists for Patients Diagnosed with Prostate Cancer: Results from a National Survey

Background: Magnetic resonance imaging (MRI) of the prostate and fusion biopsy have been advanced to improve the detection of clinically significant prostate cancer (PCa). Yet, frequency of their use and contemporary attitudes among radiation oncologists (ROs) and urologists (UROs) remain largely unknown. Objective: We performed a national survey of UROs and ROs to assess the perceived attitudes towards and frequency of prostate MRI and fusion biopsy. Design, setting, and participants: We conducted a national survey of 915 ROs and 940 UROs about prostate MRI and fusion biopsy in 2017. Outcome measurements and statistical analysis: The survey queried respondents about perceptions of prostate MRI and fusion biopsy and inquired about self-reported utilization. Pearson chi-square test and multivariable logistic regression were used to identify physician characteristics associated with survey responses. Results and limitations: The overall response rate was 37% (n = 691). Both UROs and ROs demonstrated similar positive views that MRI with fusion biopsy improves PCa risk stratification (67% vs 71%; p = 0.19) and fusion biopsy increases the confidence recommending active surveillance (55% vs 60%; p = 0.18). Yet, only a quarter of both specialties reported frequent use of prostate MRI for treatment decisions for low- and intermediate-risk PCa. Compared with respondents practicing in community practices, those in academic practices were more likely to report using prostate MRI for low- (44% vs 19%; adjusted odds ratio [OR]: 3.96; p < 0.001) and intermediate-risk PCa (42% vs 24%; adjusted OR: 2.49; p < 0.001). Our study was limited by a modestly lower response rate. Conclusions: While both specialties have perceived value in favor of prostate MRI and fusion biopsy, only a quarter of respondents report their use in clinical practice. Physicians practicing in academic medical centers had greater self-reported use. Patient summary: Magnetic resonance imaging of the prostate and targeted biopsies have growing evidence of their use as a superior diagnostic methodology for prostate cancer diagnosis and treatment decisions. Our survey study found that a majority of radiation oncologists and urologists view both favorably in improving prostate cancer detection and treatment decisions. Yet, only a quarter report using it in routine clinical practice for men diagnosed with prostate cancer. In our national survey, a majority of radiation oncologists and urologists perceive prostate magnetic resonance imaging and targeted biopsies as improving risk stratification for prostate cancer and confident in recommending active surveillance. However, only a quarter of respondents self-report using it in clinical practice.