UNC Urology faculty continue to lead the national conversation on advancing diagnostic excellence, as highlighted in a recent AUA Spotlight article authored by Drs. Zach Feuer, Hung-Jui (Ray) Tan, and Matthew Nielsen.
Published in the May 2025 issue of AUA News, the article, “Advancing Diagnostic Excellence in Prostate Cancer: Insights From the Quality Summit on Prostate MRI,” underscores the critical role of MRI quality in modern prostate cancer care, and how UNC’s model is helping chart the course forward.
Elevating MRI Quality to Improve Outcomes
At the heart of the article is the insight that multiparametric MRI has revolutionized how clinicians stratify prostate cancer risk and guide biopsy decisions. But with its growing adoption has come a sobering reality: not all MRI scans are created equal.
The AUA’s 2024 Quality Summit on Prostate MRI brought together national experts in urology and radiology to confront this challenge. UNC Urology’s contributions were front and center, detailing institutional efforts to integrate high-quality imaging into a precision diagnostic workflow, ensuring that MRI is not only used but used well.
Drs. Feuer, Tan, and Nielsen highlighted key barriers in the field: inconsistent MRI image quality, variable radiologist experience, and a lack of standardization in interpretation and biopsy technique. They emphasized that overcoming these gaps requires a coordinated, quality-focused strategy, one that UNC has been actively developing and refining.
A Model for MRI Integration in Clinical Practice
UNC’s institutional experience serves as a case study in the article, showcasing the department’s structured approach to prostate cancer diagnosis. All eligible men at UNC undergo a confirmatory PSA and pre-biopsy MRI with progression to biopsy determined by findings (PI-RADS ≥3) or high-risk features such as Black race or family history.
This approach has produced meaningful results:
- Nearly 50% reduction in unnecessary biopsies
- Increased detection of clinically significant cancers
- Streamlined access and improved patient experience
These outcomes echo earlier findings shared by Drs. Tan and Feuer at the AUA’s 2024 Expert Convening, where they presented UNC’s rapid access program. That three-step diagnostic model, initial consult, MRI, and targeted biopsy, led to the avoidance of biopsy in nearly one-third of men with elevated PSA. Meanwhile, efforts to enhance access to care reduced referral-to-biopsy time by 70%.
Setting the National Agenda: From UNC to the AUA
The article also underscores the leadership role that UNC faculty play in shaping national standards. Dr. Nielsen, Chair of the AUA’s Science and Quality Council, has been instrumental in efforts to elevate MRI quality nationwide. The piece highlights collaborative initiatives like the ACR’s Prostate MR Image Quality Improvement Collaborative and the adoption of PI-QUAL scoring, which help ensure imaging meets rigorous, reproducible standards.
Further, UNC’s engagement with the Michigan Urological Surgery Improvement Collaborative (MUSIC) and other national partners reflects a commitment to exporting best practices and closing diagnostic gaps in real-world settings.
Looking Ahead: Technology, Training, and Parity
As Dr. Nielsen noted in a related Inside Tract podcast:
“High-quality imaging means better decisions, fewer unnecessary biopsies, and more timely access to the care that matters most.”
More About the Authors
Dr. Nielsen is the Chair and Professor of Urology and member of the Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill. Dr. Nielsen is also the Chair of the AUA’s Science and Quality Council.
Dr. Tan is the Division Chief of Urologic Oncology, Urologic Oncology Fellowship Program Director, Associate Professor of Urology, and member of the Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill. Dr. Tan is also the Chair for AUA’s Data Committee, a committee of the Science and Quality Council.
Dr. Zachary Feuer is currently a Urologic Oncology Fellow and incoming Assistant Professor with UNC Urology.