An Examination of Racial and Ethnic Disparities in the Use of Prostate Biopsy and Magnetic Resonance Imaging in Prostate Cancer Screening

Abstract

Study Need and Importance: Prostate cancer (PCa) is the second most common cancer diagnosis in men, particularly affecting Black men, who experience higher incidence and mortality rates compared to other racial groups. This study investigated racial and ethnic disparities in the utilization of follow-up testing (biopsy or MRI) after an abnormal PSA result. What We Found: Using insurance claims data from a sample of 765,409 male patients, we observed that Black men were more likely to undergo follow-up testing after an elevated PSA result compared to White men, which is congruent with their relative PCa risk. Additionally, Asian and Hispanic men had lower rates of follow-up testing compared to White men, which is also congruent with their relative PCa risk. These disparities were consistent across different age groups, but most pronounced among patients aged 65-74.Limitations: This study utilized retrospective claims data for patients enrolled in a single health plan, and the data did not include detailed clinical information such as disease severity or patient preferences. Additionally, the data are proprietary and are not available for further analysis. Interpretation for Patient Care: Our findings suggest that physicians rely on the reported statistical incidence of PCa among different racial and ethnic groups to guide decision-making for follow-up testing in patients with elevated PSA levels. Notably, our findings highlight that Black men have the highest likelihood of undergoing a follow-up prostate test, followed by White, Hispanic, and Asian patients. These results underscore the significance of publishing statistical data on disease incidence categorized by race and ethnicity, as the data play a critical role in informing physician decision-making and risk stratification.

Reply by Authors

“…We appreciate the concerns raised in Manfredi and Autorino’s comment about our work. As they note, we were careful to highlight the limitations of the study, 1 which must be considered when interpreting the data. However, our study complements rather than contradicts previous research.…”