Contemporary Trends in Magnetic Resonance Imaging at the Time of Prostate Biopsy: Results from a Large Private Insurance Database

Kim, Simon P.; Karnes, R. Jeffrey; Mwangi, Raphael; Houten, Holly Van; Gross, Cary P.; Gershman, Boris; Leapman, Michael; Shah, Nilay D.

doi:10.1016/j.euf.2019.03.016

Cited by 31 publications

(27 citation statements)

References 25 publications

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“…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. Black patients with prostate cancer experience more frequent delays until prostatectomy, less frequent use of lymph node dissection, and inferior postoperative outcomes compared with non-Hispanic White men.…”

Section: Discussionsupporting

confidence: 88%

“…Notably, our findings of disparities in prostate MRI use among Hispanic/Latino men compared with non‐Hispanic White men have not been reported before. Rosenkrantz et al did not examine this group separately, and Kim et al did not observe disparities in MRI use among privately insured men of Hispanic/Latino ethnicity 10,12 . Other work has found disparities in prostate cancer care for Hispanic/Latino men in other domains.…”

Section: Discussionmentioning

confidence: 97%

“…Rosenkrantz et al did not examine this group separately, and Kim et al did not observe disparities in MRI use among privately insured men of Hispanic/Latino ethnicity. 10,12 Other work has found disparities in prostate cancer care for Hispanic/Latino men in other domains. Hispanic/Latino patients with prostate cancer are less likely to receive treatment for prostate cancer compared with White men.…”

Section: Discussionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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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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“…Multiparametric magnetic resonance imaging (mpMRI) is increasingly employed as a diagnostic tool following multiple studies demonstrating the accuracy in prostate cancer detection in men with an elevated prostate specific antigen (PSA) level or other clinical suspicion such as an abnormal digital rectal examination (DRE) [1]. Prior to the mpMRI era, serum PSA testing and DRE alone were used to inform decision-making about proceeding to prostate biopsy using transrectal ultrasound (TRUS), an imaging modality that is targeted to the prostate alone, rather than suspicious lesions, and does not provide adequate visualisation of intra-prostatic lesions.…”

Section: Introductionmentioning

confidence: 99%

Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in the Detection of Clinically Significant Prostate Cancer in the Prostate Imaging Reporting and Data System Era: A Systematic Review and Meta-analysis

et al. 2020

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Reviewer #4: The authors are still failing to take the problem of heterogeneity seriously. The latest response was "well, yes, the results are all over the place, but most results are pretty good". First off, it is not at all clear to this reviewer that a negative predictive value of 85%, the threshold used by the authors, is acceptable. Would most patients be happy to be told that they only have a 15% risk of high-grade cancer, so not to worry about it? That is approximately the risk for a PSA of 10. How many urologists would argue against giving a biopsy to a man with a PSA of 10?Second, the point about heterogeneity is absolutely not to find out where the majority of results lie. For instance, if this was a meta-analysis of complication risk after abortion, and there was gross heterogeneity, with most clinics having very low rates and a few having very high rates, I'm pretty sure the conclusion wouldn't be only that "abortion is a safe procedure". More likely, there would be something about there being some unsafe clinics, and then an analysis to determine the characteristics of those clinics (e.g. solo practice) or a call for further research to determine why some clinics have poor outcomes. The current paper reads as if the authors came up with the conclusion first and then went through the motions of reporting forest plots and I2 statistics and so on. The conclusion that "Multiparametric MRI of the prostate is an accurate test for ruling-out clinically significant prostate cancer" is simply not an appropriate reflection of the data presented by the authors.Formatted: Font: Bold Commented [AL1]: I know we'd already done it but we don't need to point that out to AV. Hopefully he'll think we've now spotted the wisdom of his words and made the change requested. Don't want to give him any reason to dig his heals in.

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“…Because Medicare in the United States is limited to those 65 years old or older, we limited our study to subjects 66 years old or older in order to have at least 1 year of enrollment to ascertain prior prostate biopsy status (see the Materials and Methods section of our article 4 ). The difference in final cohort sizes (10,531 vs 494), as pointed out by the commentators, reflects the relatively low prostate MRI utilization rates before biopsy during the time period of the study, 5 which were expected.…”

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confidence: 97%

Reply to The risk factors of upgrading in prostate cancer

Shoag

Cai

Groß

et al. 2020

Cancer

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Contemporary Trends in Magnetic Resonance Imaging at the Time of Prostate Biopsy: Results from a Large Private Insurance Database

Cited by 31 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

Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in the Detection of Clinically Significant Prostate Cancer in the Prostate Imaging Reporting and Data System Era: A Systematic Review and Meta-analysis

Reply to The risk factors of upgrading in prostate cancer

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