National implementation of multi‐parametric magnetic resonance imaging for prostate cancer detection – recommendations from a UK consensus meeting

Abstract

Objectives

To identify areas of agreement and disagreement in the implementation of multi‐parametric magnetic resonance imaging (mp MRI) of the prostate in the diagnostic pathway.

Materials and Methods

Fifteen UK experts in prostate mp MRI and/or prostate cancer management across the UK (involving nine NHS centres to provide for geographical spread) participated in a consensus meeting following the Research and Development Corporation and University of California‐Los Angeles ( UCLA‐ RAND) Appropriateness Method, and were moderated by an independent chair. The experts considered 354 items pertaining to who can request an mp MRI, prostate mp MRI protocol, reporting guidelines, training, quality assurance ( QA) and patient management based on mp MRI levels of suspicion for cancer. Each item was rated for agreement on a 9‐point scale. A panel median score of ≥7 constituted ‘agreement’ for an item; for an item to reach ‘consensus’, a panel majority scoring was required.

Results

Consensus was reached on 59% of items (208/354); these were used to provide recommendations for the implementation of prostate mp MRI in the UK. Key findings include prostate mp MRI requests should be made in consultation with the urological team; mp MRI scanners should undergo QA checks to guarantee consistently high diagnostic quality scans; scans should only be reported by trained and experienced radiologists to ensure that men with unsuspicious prostate mp MRI might consider avoiding an immediate biopsy.

Conclusions

Our consensus statements demonstrate a set of criteria that are required for the practical dissemination of consistently high‐quality prostate mp MRI as a diagnostic test before biopsy in men at risk.