Adoption of Prebiopsy Magnetic Resonance Imaging for Men Undergoing Prostate Biopsy in the United States

Liu, Wen; Patil, Dattatraya; Howard, David H.; Moore, Reneé H.; Wang, Heqiong; Sanda, Martin G.; Filson, Christopher P.

doi:10.1016/j.urology.2018.04.007

Cited by 45 publications

(27 citation statements)

References 25 publications

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“…10 Similar trends have been observed among those covered by commercial insurance plans. 11,12 Our observation that non-Hispanic Black patients with prostate cancer were less likely to undergo prebiopsy MRI also paralleled previously published findings among Medicare beneficiaries and privately insured men. 10,12 This finding is yet another example of disparate prostate cancer care received by Black men.…”

Section: Discussionsupporting

confidence: 88%

Disparities in magnetic resonance imaging of the prostate for traditionally underserved patients with prostate cancer

Quinn

Sanda

Howard

et al. 2021

Cancer

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BACKGROUND: Prebiopsy magnetic resonance imaging (MRI) of the prostate improves detection of significant tumors, while decreasing detection of less-aggressive tumors. Therefore, its use has been increasing over time. In this study, the use of prebiopsy MRI among Medicare beneficiaries with prostate cancer was examined. It was hypothesized that patients of color and those in isolated areas would be less likely to undergo this approach for cancer detection. METHODS: Using cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) program linked to billing claims for fee-for-service Medicare beneficiaries, men with nonmetastatic prostate cancer were identified from 2010 through 2015 with prostate-specific antigen (PSA) <30 ng/mL. Outcome was prebiopsy MRI of the prostate performed within 6 months before diagnosis (ie, Current Procedural Terminology 72197). Exposures were patient race/ethnicity and rural/urban status. Multivariable regression estimated the odds of prebiopsy prostate MRI. Post hoc analyses examined associations with the registry-level proportion of non-Hispanic Black patients and MRI use, as well as disparities in MRI use in registries with data on more frequent use of prostate MRI. RESULTS: There were 50,719 men identified with prostate cancer (mean age, 72.1 years). Overall, 964 men (1.9% of cohort) had a prebiopsy MRI. Eighty percent of patients with prebiopsy MRI lived in California, New Jersey, or Connecticut. Non-Hispanic Black men (0.6% vs 2.1% non-Hispanic White; odds ratio [OR], 0.28; 95% CI, 0.19-0.40) and men in less urban areas (1.1% vs 2.2% large metro; OR, 0.65; 95% CI, 0.44-0.97) were less likely to have prebiopsy MRI of the prostate. CONCLUSIONS: Non-Hispanic Black patients with prostate cancer and those in less urban areas were less likely to have prebiopsy MRI of the prostate during its initial adoption as a tool for improving prostate cancer detection.

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Section: Discussionsupporting

confidence: 88%

Disparities in magnetic resonance imaging of the prostate for traditionally underserved patients with prostate cancer

Quinn

Sanda

Howard

et al. 2021

Cancer

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“…Secondly, prostate mpMRI and other adjunctive classifying tools were not routinely performed on our present patient population. However, in current contemporary practice, only 6.5% of biopsy‐naïve men undergo prostate MRI before biopsy . Our present study is therefore germane to the current state of urological practice.…”

Section: Discussionmentioning

confidence: 93%

Effects of pathological upstaging or upgrading on metastasis and cancer‐specific mortality in men with clinical low‐risk prostate cancer

et al. 2018

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“…The use of mpMRI has become common practice in large academic institutions; however, 70% of community hospitals have not adopted such practice and 75% of hospitals perform few mpMRI (< 20 mpMRI/month) [22]. Currently, a patient’s geographic location (non-urban settings) and insurance type (health maintenance organizations) greatly reduce their chances of having access to a mpMRI [22, 23]. The accuracy of mpMRI in community settings is also risky with only 55% concordance between community and expert academic radiologists [24].…”

Section: Discussionmentioning

confidence: 99%

A comparative effectiveness analysis of the PBCG vs. PCPT risks calculators in a multi-ethnic cohort

et al. 2019

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BackgroundPredictive models that take race into account like the Prostate Cancer Prevention Trial Risk Calculator 2.0 (PCPT RC) and the new Prostate Biopsy Collaborative Group (PBCG) RC have been developed to equitably mitigate the overdiagnosis of prostate specific antigen (PSA) screening. Few studies have compared the performance of both calculators across racial groups.MethodsFrom 1485 prospectively recruited participants, 954 men were identified undergoing initial prostate biopsy for abnormal PSA or digital rectal examination in five Chicago hospitals between 2009 and 2014. Discrimination, calibration, and frequency of avoided biopsies were calculated to assess the performance of both risk calculators.ResultsOf 954 participants, 463 (48.5%) were Black, 355 (37.2%) were White, and 136 (14.2%) identified as Other. Biopsy results were as follows: 310 (32.5%) exhibited no cancer, 323 (33.9%) indolent prostate cancer, and 321 (33.6%) clinically significant prostate cancer (csPCa). Differences in area under the curve (AUC)s for the detection of csPCa between PCPT and PBCG were not statistically different across all racial groups. PBCG did not improve calibration plots in Blacks and Others, as it showed higher levels of overprediction at most risk thresholds. PCPT led to an increased number of avoidable biopsies in minorities compared to PBCG at the 30% threshold (68% vs. 28% of all patients) with roughly similar rates of missed csPCa (23% vs. 20%).ConclusionSignificant improvements were noticed in PBCG’s calibrations and net benefits in Whites compared to PCPT. Since PBCG’s improvements in Blacks are disputable and potentially biases a greater number of low risk Black and Other men towards unnecessary biopsies, PCPT may lead to better biopsy decisions in racial minority groups. Further comparisons of commonly used risk calculators across racial groups is warranted to minimize excessive biopsies and overdiagnosis in ethnic minorities.

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Adoption of Prebiopsy Magnetic Resonance Imaging for Men Undergoing Prostate Biopsy in the United States

Cited by 45 publications

References 25 publications

Disparities in magnetic resonance imaging of the prostate for traditionally underserved patients with prostate cancer

Disparities in magnetic resonance imaging of the prostate for traditionally underserved patients with prostate cancer

Effects of pathological upstaging or upgrading on metastasis and cancer‐specific mortality in men with clinical low‐risk prostate cancer

A comparative effectiveness analysis of the PBCG vs. PCPT risks calculators in a multi-ethnic cohort

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