Investigators have estimated the environmental impacts of prostate magnetic resonance imaging (MRI) scans and prostate biopsies, according to a new study published by Michael S. Leapman, MD, MHS, and colleagues in European Urology. The findings suggest that more carefully selecting patients for prostate biopsies in a way that can also avoid low-yield and potentially harmful procedures may hold potential environmental benefits.
Michael S. Leapman, MD, MHS
Background
Prostate biopsies are often the main diagnostic tests for patients with prostate cancer. Approximately 1 million prostate biopsies are performed in the United States per year, yet more than half of patients who are being evaluated for an elevated prostate-specific antigen are found to have no prostate cancer.
Previous studies have found that the health-care industry is a major source of pollution worldwide—but to date, no tangible figures existed of the environmental impact of prostate biopsies and/or MRIs.
“We continue to see many medical and diagnostic procedures being used more often than recommended by clinical guidelines—increasing health-care costs and, in some cases, directly harming patients,” explained first study author Dr. Leapman, Associate Professor of Urology at the School of Medicine and Clinical Program Leader of the Prostate & Urologic Cancers Program at the Yale Cancer Center at Yale University. “A dimension that has been less studied is the environmental impact of care that is already considered low-value or unnecessary. In this analysis, we estimate[d] the carbon footprint of a prostate biopsy, then extrapolate[d] the potential environmental benefits of adopting various evidence-based approaches,” he added.
Study Methods and Results
In the new study, the investigators used lifecycle assessment methodology to demonstrate the impact of the procedures and calculate the potential impacts if different strategies were applied. Based on their measurements, it was estimated that performing 100,000 fewer prostate biopsies would avoid 8.1 million kg of carbon dioxide emissions—the equivalent of burning 1.1 million gallons of gasoline. If prostate MRIs were used more to select the patients who need to undergo prostate biopsies, 1.4 million kg of carbon dioxide equivalent emissions could be reduced per 100,000 patients—the equivalent of burning 184,920 gallons of gasoline. This approach is currently used in other countries and supported by several clinical studies.
Additionally, the investigators likened performing both an MRI and prostate biopsy to taking a “round-trip flight from London to Paris” in terms of energy usage, staff travel, and supply production.
Conclusions
The researchers hope their findings will help educate patients and physicians on the connection between potential environmental benefits and evidence-based care, and highlighted that sustainability efforts should be aligned with patient interests and scientific evidence. “We are already cognizant of the physical, emotional, and economic consequences of overdiagnosing and overtreating patients with prostate cancer,” underscored Dr. Leapman. “We hope this work adds depth to the discussion by providing concrete estimates of [the] health-care pollution and environmental impact also incurred through these procedures,” he concluded.
The investigators stressed that well-studied strategies can help select patients more carefully for invasive diagnostic procedures while also having a positive environmental benefit.
Disclosure: For full disclosures of the study authors, visit sciencedirect.com.
