Detection of prostate cancer using magnetic resonance imaging/ultrasonography image‐fusion targeted biopsy in African‐American men

Shin, Toshitaka; Smyth, Thomas B.; Ukimura, Osamu; Ahmadi, Nariman; Abreu, André Luís de Castro; Oishi, Masamichi; Mimata, Hiromitsu; Gill, Inderbir S.

doi:10.1111/bju.13786

Cited by 19 publications

(9 citation statements)

References 26 publications

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“…Multi-parametric MRI (mpMRI) for prostate cancer detection in AA men was evaluated in a retrospective study that included 117 AA and 544 CA men. In this study, there was no racial difference in the detection rate of overall prostate cancers or clinically significant prostate cancers between AA and CA men on mpMRI ( 31 ). Another study including 822 men (127 AA) found that MRI/ultrasound-guided fusion biopsy demonstrated increased diagnostic yield in the AA population in an age- and PSA-matched cohort of CA patients ( 32 ).…”

Section: Diagnostic Modalities For Prostate Cancer In African Americamentioning

confidence: 48%

Rethinking active surveillance for prostate cancer in African American men

Leinwand

Gabrielson

Krane

et al. 2018

Transl. Androl. Urol.

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Active surveillance (AS) is a treatment modality for prostate cancer that aims to simultaneously avoid overtreatment and allow for the timely intervention of localized disease. AS has become the de facto standard of care for most men with low-risk prostate cancer. However, few African American (AA) men were included in the prospective observational cohorts that resulted in a paradigm shift in treatment recommendations from active intervention toward AS. It has been established that AA men have an increased prostate cancer incidence, higher baseline prostate-specific antigen (PSA) values, more aggressive prostate cancer features, greater frequency of biochemical recurrence after treatment, and higher overall cancer-specific mortality compared to their Caucasian counterparts. As such, this has given many physicians pause before initiating AS for AA patients. In the following manuscript, we will review the available literature regarding AS, with a particular focus on AA men. The preponderance of evidence demonstrates that AS is as viable a management method for AA with low-risk prostate cancer as it is with other racial groups.

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Section: Diagnostic Modalities For Prostate Cancer In African Americamentioning

confidence: 48%

Rethinking active surveillance for prostate cancer in African American men

Leinwand

Gabrielson

Krane

et al. 2018

Transl. Androl. Urol.

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“…However, Shin et al . reported there was a 47% detection rate of prostate cancer among MRUS TB biopsied Likert score 3 in African American patients, 55% of those were clinically significant cancer . Because there is significant variability in the detection rate of prostate cancer in biopsied Likert score 3 lesions, how to manage patients with Likert score 3 lesions remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy using three‐dimensional ultrasound‐based organ‐tracking technology: Initial experience in Japan

et al. 2019

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Objective To evaluate the impact of magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy on the diagnosis of clinically significant prostate cancer using real‐time three‐dimensional ultrasound‐based organ‐tracking technology. Methods The present study was a retrospective review of 262 consecutive patients with prostate‐specific antigen of 7.1 ng/mL (interquartile range 4.0–19.8). All patients received pre‐biopsy magnetic resonance imaging and had a suspicious lesion for clinically significant prostate cancer. All patients underwent a combination of systematic biopsy (6 cores) and three‐dimensional ultrasound‐based magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (2 cores). The positive rate of any cancer, positive rate of clinically significant prostate cancer, Gleason score and maximum cancer core length were compared between systematic biopsy versus magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy. Results Overall, the positive rate of any cancer per patient was 61% (160/262) in systematic biopsy versus 79% (207/262) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P < 0.0001); and that of clinically significant prostate cancer per patient was 46% (120/262) in systematic biopsy versus 70% (181/262) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P < 0.0001). The positive rate of any cancer per core was 21.7% (330/1523) in systematic biopsy versus 68.6% (406/592) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P < 0.0001), and that of clinically significant prostate cancer per core was 12.7% (193/1423) in systematic biopsy versus 60.3% (357/592) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P < 0.0001). Adding systematic biopsy leads to 13 more cancer cases (5%). The distribution of Gleason score (6/7/8/9/10) was 59/71/23/6/1 in systematic biopsy versus 48/105/36/15/2 in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P = 0.005). The maximum cancer core length was 5 mm (0.5–16) in systematic biopsy versus 8 mm (1–19 mm) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P < 0.0001). Conclusions Three‐dimensional ultrasound‐based magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy seems to be associated with a higher detection rate of clinically significant prostate cancer, with fewer cores than systematic random biopsy. However, significant cancer can still be detected by the systematic technique only. A combination of systematic biopsy with the targeted biopsy technique would avoid the underdiagnosis of clinically significant prostate cancer.

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“…17 Prostate MRI may identify suspicious regions in the prostate to target for subsequent biopsy, significantly increasing the likelihood of identifying clinically meaningful prostate cancer, 18 and prostate cancer detection by MRI-targeted biopsy is not significantly different between Black vs White patients. 19 Additionally, a prostate MRI may obviate the need for biopsy, thus decreasing the overdiagnosis of insignificant prostate cancer. 20 The American Urological Society (AUA) and National Comprehensive Cancer Network have both recognized the important role of prostate MRI for prostate cancer diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, prostate magnetic resonance imaging (MRI) has emerged as a means to evaluate men with an elevated PSA before possible prostate biopsy and its use is rapidly increasing nationally . Prostate MRI may identify suspicious regions in the prostate to target for subsequent biopsy, significantly increasing the likelihood of identifying clinically meaningful prostate cancer, and prostate cancer detection by MRI-targeted biopsy is not significantly different between Black vs White patients . Additionally, a prostate MRI may obviate the need for biopsy, thus decreasing the overdiagnosis of insignificant prostate cancer …”

Section: Introductionmentioning

confidence: 99%

Racial and Ethnic Disparities in the Use of Prostate Magnetic Resonance Imaging Following an Elevated Prostate-Specific Antigen Test

et al. 2021

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IMPORTANCE Prostate cancer screening and diagnosis exhibit known racial and ethnic disparities.Whether these disparities persist in prostate magnetic resonance imaging (MRI) utilization after elevated prostate-specific antigen (PSA) results is poorly understood. OBJECTIVETo assess potential racial and ethnic disparities in prostate MRI utilization following elevated PSA results. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 794 809 insured US men was drawn from deidentified medical claims between January 2011 and December 2017 obtained from a commercial claims database. Eligible participants were aged 40 years and older and received a single PSA result and no prior PSA screening or prostate MRI claims. Analysis was performed in January 2021. MAIN OUTCOMES AND MEASURES Multivariable logistic regression was used to examineassociations between elevated PSA results and follow-up prostate MRI. For patients receiving prostate MRI, multivariable regressions were estimated for the time between PSA and subsequent prostate MRI. PSA thresholds explored included PSA levels above 2.5 ng/mL, 4 ng/mL, and 10 ng/mL.Analyses were stratified by race, ethnicity, and age. RESULTSOf 794 809 participants, 51 500 (6.5%) had PSA levels above 4 ng/mL; of these, 1524 (3.0%) underwent prostate MRI within 180 days. In this sample, mean (SD) age was 59.8 (11.3) years (range 40-89 years); 31 350 (3.9%) were Asian, 75 935 (9.6%) were Black, 107 956 (13.6%) were Hispanic, and 455 214 (57.3%) were White. Compared with White patients, Black patients with PSA levels above 4 ng/mL and 10 ng/mL were 24.1% (odds ratio [OR], 0.78; 95% CI, 0.65-0.89) and 35.0% (OR, 0.65; 95% CI, 0.50-0.85) less likely to undergo subsequent prostate MRI, respectively. Asian patients with PSA levels higher than 4 ng/mL (OR, 0.76; 95% CI, 0.58-0.99) and Hispanic patients with PSA levels above 10 ng/mL (OR, 0.77; 95% CI, 0.59-0.99) were also less likely to undergo subsequent prostate MRI compared with White patients. Black patients between ages 65 and 74 years with PSA above 4 ng/mL and 10 ng/mL were 23.6% (OR, 0.76; 95% CI, 0.64-0.91) and 43.9% (OR, 0.56; 95% CI, 0.35-0.91) less likely to undergo MRI, respectively. Race and ethnicity were not significantly associated with mean time between PSA and MRI.CONCLUSIONS AND RELEVANCE Among men with elevated PSA results, racial and ethnic disparities were evident in subsequent prostate MRI utilization and were more pronounced at higher PSA thresholds. Further research is needed to better understand and mitigate physician decisionmaking biases and other potential sources of disparities in prostate cancer diagnosis and management.

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Detection of prostate cancer using magnetic resonance imaging/ultrasonography image‐fusion targeted biopsy in African‐American men

Abstract: Our key finding confirms a lack of racial difference in the detection rate of overall prostate cancers and CSPC with MRI/US FTB between A-A and Caucasian men. MRI/US FTB detected more CSPC using fewer cores compared with random biopsy.

Cited by 19 publications

References 26 publications

Rethinking active surveillance for prostate cancer in African American men

Rethinking active surveillance for prostate cancer in African American men

Magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy using three‐dimensional ultrasound‐based organ‐tracking technology: Initial experience in Japan

Racial and Ethnic Disparities in the Use of Prostate Magnetic Resonance Imaging Following an Elevated Prostate-Specific Antigen Test

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