Environmental Impact of Prostate Magnetic Resonance Imaging and Transrectal Ultrasound Guided Prostate Biopsy

Background: Reducing low-value clinical care is an important strategy to mitigate envi-ronmental pollution caused by health care. Objective: To estimate the environmental impacts associated with prostate magnetic resonance imaging (MRI) and prostate biopsy. Design, setting, and participants: We performed a cradle-to-grave life cycle assessment of prostate biopsy. Data included materials and energy inventory, patient and staff travel contributed by prostate MRI, transrectal ultrasound guided prostate biopsy, and pathol-ogy analysis. We compared environmental emissions across five clinical scenarios: mul-tiparametric MRI (mpMRI) of the prostate with targeted and systematic biopsies (baseline), mpMRI with targeted biopsy cores only, systematic biopsy without MRI, mpMRI with systematic biopsy, and biparametric MRI (bpMRI) with targeted and sys-tematic biopsies. We estimated the environmental impacts associated with reducing the overall number and varying the approach of a prostate biopsy by using MRI as a triage strategy or by omitting MRI. The study involved academic medical centers in the USA, outpatient urology clinics, health care facilities, medical staff, and patients. Outcome measurements and statistical analysis: Greenhouse gas emissions (CO2 equiva-lents, CO2e), and equivalents of coal and gasoline burned were measured.Results and limitations: In the USA, a single transrectal prostate biopsy procedure including prostate MRI, and targeted and systematic biopsies emits an estimated 80.7 kg CO2e. An approach of MRI targeted cores alone without a systematic biopsy gen-erated 76.2 kg CO2e, a systematic 12-core biopsy without mpMRI generated 36.2 kg CO2e, and bpMRI with targeted and systematic biopsies generated 70.5 kg CO2e; mpMRI alone contributed 42.7 kg CO2e (54.3% of baseline scenario). Energy was the largest contributor, with an estimated 38.1 kg CO2e, followed by staff travel (20.7 kg CO2e) and supply production (11.4 kg CO2e). Performing 100 000 fewer unnecessary biopsies would avoid 8.1 million kg CO2e, the equivalent of 4.1 million liters of gasoline consumed. Per 100 000 patients, the use of prostate MRI to triage prostate biopsy and guide targeted biopsy cores would save the equivalent of 1.4 million kg of CO2 emissions, the equivalent of 700 000 l of gasoline consumed. This analysis was limited to prostate MRI and biopsy, and does not account for downstream clinical management. Conclusions: A prostate biopsy contributes a calculable environmental footprint. Modifying or reducing the number of biopsies performed through existing evidence -based approaches would decrease health care pollution from the procedure. Patient summary: We estimated that prostate magnetic resonance imaging (MRI) with a prostate biopsy procedure emits the equivalent of 80.7 kg of carbon dioxide. Performing fewer unnecessary prostate biopsies or using prostate MRI as a tool to decide which patients should have a prostate biopsy would reduce procedural greenhouse gas emis-sions and health care pollution.(c) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.