Surgery (Austin & Northern Health) - Theses
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ItemHealth economic analysis and the role of multiparametric magnetic resonance imaging in prostate cancer( 2023-08)Prostate cancer is the most common solid organ malignancy diagnosed in men. Its diagnosis has historically relied on clinical examination, prostate-specific antigen (PSA) screening and biopsy based on transrectal ultrasound. However, ultrasound is not sensitive in identifying abnormal, potentially cancerous areas in the prostate and therefore biopsy has been performed in a ‘random’ fashion that has led to missing clinically significant disease and over-diagnosing indolent disease. Developments in multiparametric magnetic resonance imaging (mpMRI) technology have suggested that it may be superior modality for local imaging of the prostate gland. This thesis will assess the role of mpMRI in the prostate cancer diagnostic pathway. The diagnostic accuracy of mpMRI was assessed to determine the sensitivity of abnormal mpMRI findings and the negative predictive value of a normal mpMRI. The latter is especially important in the proposal to use mpMRI as a tool to identify which men with an elevated PSA need to proceed to prostate biopsy. I will also assess which MRI findings in different populations of men should be recommended for biopsy. In addition, I will develop a nomogram to determine which men needed systematic sampling at the time of their prostate biopsy for accurate diagnosis of their disease and which men can be accurately diagnosed using targeted biopsy alone. Finally, I will perform an economic assessment to determine the cost-effectiveness of incorporating mpMRI in the primary biopsy setting and for men on active surveillance.