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

Abstract

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.

Racial disparities in Black men with prostate cancer: A literature review

“…In lower income populations, White men had higher odds of receiving PSA monitoring versus Black men (OR, 1.15; 95% CI, 1.08–1.22) 68 . Among insured men who had elevated PSA results between 2011 and 2017, Black men were less likely to undergo subsequent prostate magnetic resonance imaging compared with White men 69 . In addition, in real‐world clinical practice, Black men were less likely to receive comprehensive genomic profiling earlier in their treatment course compared with men of European ancestry 70 .…”

“… 68 Among insured men who had elevated PSA results between 2011 and 2017, Black men were less likely to undergo subsequent prostate magnetic resonance imaging compared with White men. 69 In addition, in real‐world clinical practice, Black men were less likely to receive comprehensive genomic profiling earlier in their treatment course compared with men of European ancestry. 70 In contrast, another retrospective study of 3083 Black men and 1704 White men who underwent RP in multiple VA medical centers reported that Black men of low SES experienced a decreased risk of post‐RP castration‐resistant prostate cancer, metastasis, and PCSM versus White men.…”

A narrative review of biparametric MRI (bpMRI) implementation on screening, detection, and the overall accuracy for prostate cancer

“…They further confirmed that patients who lived in areas with a high education level and median household income ⩾$60,001 had a higher likelihood of receiving an mpMRI regardless of clinical presentation of disease. A recent study from Abashidze et al 48 further elucidated racial disparities among MRI utilization. From 2011 to 2017, MRI has in increasing utilization across all races.…”

“…A recent study from Abashidze et al. 48 further elucidated racial disparities among MRI utilization. From 2011 to 2017, MRI has in increasing utilization across all races.…”

Health Disparities in Prostate Cancer and Approaches to Advance Equitable Care

“…9 Another recent study of nearly 800,000 commercially insured men undergoing a prostatespecific antigen test between 2011 and 2017 reported that Black and Hispanic patients were significantly less likely than White patients to undergo prostate MRI after receiving an elevated prostate-specific antigen test result, highlighting a need to better understand and mitigate physician decision-making biases and other potential sources of these disparities. 10 Most recently, the extension of such imaging disparities to modern molecular imaging tracers was demonstrated in a single U.S. tertiary medical center review of 1,756 patients: 1,502 receiving 68 Ga-PSMA-11 and 254 receiving 18 F-fluciclovine. Black patients had increased odds of receiving imaging with 18 F-fluciclovine versus 68 Ga-PSMA-11 compared with non-Hispanic White patients (odds ratio, 3.88; 95% CI, 1.90-7.91), and there were no other statistically significant differences across other demographic categories assessed.…”