Morbidity and cost implications of shifting from routine transrectal ultrasound-guided prostate biopsy to mpMRI triage with selective transperineal prostate biopsy: A 12-year retrospective analysis from a tertiary referral centre

Introduction & Objectives: The diagnostic pathway for prostate cancer in patients with abnormal PSA and/or DRE has moved away from routine systematic prostate biopsy to mpMRI based triage with selective biopsy. Moreover, many centres have ceased transrectal prostate biopsies (TRPB) in favour of a transperineal (TPPB) to reduce infective complications. The cost implications of these shifts in practice have not been widely reported. This analysis describes the costs before and after a practice change in a tertiary referral centre. Methods: All men undergoing prostate biopsy at the Royal Brisbane and Women's Hospital (RBWH) between January 2006 and December 2017 were considered. A departmental shift away from TRPB in preference for mpMRI triage followed by selective TPPB occurred in 2014 following increased infective complications. Costing data were obtained for the elective biopsy admission and subsequent readmissions due to procedural complications. Results: 2,076 men underwent prostate biopsy over 12 years, comprising 1,309 TRPB and 767 TPPB with a trend towards less biopsies observed with time. The mean age was 64.68 years (SD 8.84) and 64.35 years (SD 7.78), with mean elective admission costs of $2,673 and $3,520, respectively. Following biopsy, 95 (7.2%) and 29 (3.8%) readmissions occurred following TRPB and TPPB, respectively. Readmission after TRPB were mostly due to infective complications, and after TPPB due to haematuria and urinary retention. When computing the elective admission and readmission costs, the total mean cost of each TRPB was $2,873 and TPPB $3,636. Considering that by using the mpMRI triage pathway 48% of patients avoid biopsy, the shift in practice reduced the cost per patient from $2,873 to $2,340 (including MRI cost of $450). Conclusions: Use of mpMRI triage with subsequent TPPB resulted in reduced morbidity and expenditure. This approach warrants consideration in other jurisdictions.