A survey of Canadian urologists' and radiologists' perspectives regarding the use of prostate MRI in biopsy-naive patients.

INTRODUCTION: In biopsy-naive men, guidelines now support magnetic resonance imaging (MRI) to improve detection of clinically significant prostate cancer (PCa), reduce overdiagnosis of insignificant PCa, and avoid biopsy in low-risk cases; however, the demand for MRI will be difficult to meet within the Canadian universal healthcare system. We evaluated Canadian urologists' and radiologists' practices, perceptions, and anticipated barriers to MRI implementation in this setting. METHODS: Separate surveys were iteratively developed for urologists and radiologists to inquire about the use/expected use of pre-biopsy MRI across common patient vignettes, barriers and facilitators to implementation, views on streamlining high-risk patients, and effect on wait times. RESULTS: Respondents included 175 urologists and 84 radiologists. Only 19% of urologists currently requested MRI for the majority of their patients vs. 59% who anticipated they would do so after guideline implementation. Most respondents (90%) felt that some high-risk patients could proceed directly to biopsy, but this varied by risk threshold. The highest-rated barrier to implementing guidelines was inadequate infrastructure, staffing, or MRI equipment, followed by lack of volume/expertise and reimbursement; 59% of respondents felt that pre-biopsy MRI would lead to an additional long delay (1-3 months) in diagnosis. CONCLUSIONS: This national survey of urologists and radiologists highlights broad support for using pre-biopsy mpMRI to diagnose PCa in biopsy-naive men; however, significant barriers to implementation exist, including inadequate imaging infrastructure, variable interpretive expertise, and projected increases in mpMRI-associated wait times. Our findings underscore the urgent need for coordinated health system planning to achieve equitable, guideline-concordant PCa care across Canada.