541 Investigation of Suspected Prostate Cancer In UK; Evaluation of Local Practice and Feasibility of Moving Towards MRI As First Line Investigation – Re-Audit Following Change of Radiology Staffing

NICE recommends MRI as first-line investigation for suspected clinically localised prostate cancer (PCa); previous local audit findings suggest this to be safe and feasible to implement. Recent retirement of radiology staffing however had resulted in MRIs being reported by teleconsultation radiology service. There were concerns on whether this may lead to more missed significant PCa. We performed a re-audit on our prostate MRI and biopsy to assess if this is indeed the case. Method All patients with suspected PCa who have had prostate MRI and biopsy simultaneously from April-August 2019 were retrospectively analysed. Results 222 men were included. 36% of patients with negative MRI had positive biopsies; within this group 25% had significant disease (Gleason grade group ≥2). Compared with our previous audit, specificity for significant PCa has increased (from 34% to 46%), but with a reduced negative predictive value (from 97% to 91%). Conclusions If we are to implement MRI as first-line triage for potential subsequent biopsy, it would result in more men not going for a biopsy (from 18% to 25%), a reduction in diagnosis of non-significant PCa (from 21% to 36%), but at an expense of increase in missed significant PCa (from 3% to 9%).