Preoperative Prostate MRI Underutilized
A study published June 16 in the Journal of Urology reveals that preoperative prostate MRI exams are significantly underutilized even in communities where MRI is easily accessible. Pre-op prostate MRI exams help improve surgical outcomes for prostate cancer patients — a prostate MRI provides details of tumor characteristics, useful in surgical planning.
The retrospective study was conducted by Brigham and Women’s Hospital in Boston with Dr. Alexander Cole as first author. Cole and his collaborators examined Surveillance, Epidemiology, and End Results (SEER) data of 19,369 male Medicare beneficiaries, 66 years old and older, who had non-metastatic prostate cancer and received a radical prostatectomy during the 12 months after diagnosis. The period of data studied extended from 2003 through 2016.
Usage of preoperative prostate MRI increased during the study period — from 2.9% at the beginning to 28.2%. Yet despite this ten-fold increase in preoperative prostate MRI, a study showed that over 70% of a sizable Medicare population diagnosed with prostate cancer did not receive a pre-op prostate MRI as late as 2015.
What are the benefits of preoperative prostate MRI?
The study showed the benefits of pre-op prostate MRI on prostatectomy outcomes.
- Lowers the risk of positive surgical margins
- Reduces the risk of the patient needing a blood transfusion at both 30 and 90 days post-op
- Provides the surgeon with visualization for treatment planning
- Improves nerve-sparing strategies
- Provides guidance for lymph node dissections
- Enhances bladder neck sparing decisions
In 2020, the American Urological Association (AUA) issued a statement about multiparametric prostate MRI (mpMRI) issued this statement from Marc A. Bjurlin, DO, MSc., AUA Policy Statement co-author, “There is now sufficient data to support the use of prostate MRI in all men before their initial prostate biopsy when the MRI is of sufficient quality.”
The AUA recommendation was based on their research — MRI helps decide the need for biopsy and helps ensure that the biopsy is taken from the most suspicious area. The mpMRI has been shown to detect cancer over half the time when a biopsy was negative.
Preoperative prostate MRI is significantly underutilized, with variations among regions and particular populations. Disparities were detected by race, marital status, and where one lived.
Over the period of the study, overall utilization rates were discouraging.
- White men – 10.2%
- Black men – 6.1%
- Hispanic men – 4.1%
The study also found that married men and men who lived in the same area as the hospital where they would be treated were more likely to have preoperative prostate MRI exams.
Other potential factors influencing the utilization of pre-op MRI include their surgeon’s decision to schedule the exam based on whether patients were fee-for-service Medicare beneficiaries or Medicare Advantage beneficiaries. Other factors might consist of cost and health literacy.
Increased utilization of pre-op prostate MRI will enhance cancer care. Dr. Cole postulates, “We are trying to connect with community leaders to bridge the gap between underserved communities and high-quality services. By attacking some of the variability in treatment highlighted by our study, we could potentially improve prostate cancer outcomes overall.”