Increasing Utilization of Multiparametric Magnetic Resonance Imaging in Prostate Cancer Active Surveillance

• Type of Material: Article
• Authors: Mina M. Fam, University of Pittsburgh; Jonathan G. Yabes, University of Pittsburgh; Liam C. Macleod, University of Pittsburgh; Jathin Bandari, University of Pittsburgh; Robert M. Turner, University of Pittsburgh; Samia H. Lopa, University of Pittsburgh; Alessandro Furlan, University of Pittsburgh; Christopher Filson, Emory University; Benjamin J. Davies, University of Pittsburgh; Bruce L. Jacobs, University of Pittsburgh
• Language: English
• Date: 2019-08-01
• Publisher: Elsevier Science Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.urology.2019.02.037
• Title of Journal or Parent Work: Urology
• Volume: 130
• Start Page: 99
• End Page: 104
• Grant/Funding Information: Mina M. Fam is supported in part by the Shadyside Hospital Foundation.; Bruce L. Jacobs is supported in part by the University of Pittsburgh Physicians Academic Foundation, P30CA047904 from the National Cancer Institute and the Henry L. Hillman Foundation.; Liam C. Macleod is supported in part by the Shadyside Hospital Foundation and in part by the Conquer Cancer Foundation.
• Keywords: Life Sciences & Biomedicine; MRI; Biopsy; Urology & Nephrology; Science & Technology; Ultrasound fusion
• Research Categories: Health Sciences, Radiology; Engineering, Biomedical; Biophysics, Medical

Abstract

Objective: To characterize the use of multiparametric magnetic resonance imaging (mpMRI) in male Medicare beneficiaries electing active surveillance for prostate cancer. Multi-parametric resonance imaging (mpMRI) has emerged as a tool that may improve risk-stratification and decrease repeated biopsies in men electing active surveillance. However, the extent to which mpMRI has been implemented in active surveillance has not been established. Methods: Using Surveillance, Epidemiology, and End Results (SEER) registry data linked to Medicare claims data, we identified men with localized prostate cancer diagnosed between 2008–2013 and managed with active surveillance. We classified men into two treatment groups: active surveillance without mpMRI and active surveillance with mpMRI. We then fit a multivariable logistic regression models to examine changing mpMRI utilization over time, and factors associated with the receipt of mpMRI. Results: We identified 9,467 men on active surveillance. Of these, 8,178 (86%) did not receive mpMRI and 1,289 (14%) received mpMRI. The likelihood of receiving mpMRI over the entire study period increased by 3.7% (p=0.004). On multivariable logistic regression, patients who were younger, white, had lower comorbidity burden, lived in the northeast and west, had higher incomes and lived in more urban areas had greater odds of receiving mpMRI (all p<0.05). Conclusion: From 2008–2013, use of mpMRI in active surveillance increased gradually but significantly. Receipt of mpMRI among men on surveillance for prostate cancer varied significantly across demographic, geographic and socioeconomic strata. Going forward, studies should investigate causes for this variation and define ideal strategies for equitable, cost-effective dissemination of mpMRI technology.