Preoperative MRI leads to better prostate cancer surgery outcomes, but it appears there's a racial discrepancy when it comes to which men are receiving the exam, a study published June 16 in the Journal of Urology suggests.
Despite the benefits of presurgical MRI for prostatectomy, less than a third of men overall (28.2%) undergo the exam -- and it is particularly underutilized among Black men, study first author Dr. Alexander Cole of Brigham and Women's Hospital in Boston said in a statement.
"Overdiagnosis, overtreatment, and toxicity associated with treatment are big problems with prostate cancer, but MRI can help reduce unnecessary biopsies and improve surgical outcomes," he noted. "While MRI is a tool that is changing the diagnosis and treatment of prostate cancer, our work shows that the chance of getting a preoperative prostate MRI varies significantly depending on where you happen to be living, what race you are, and on what year you were diagnosed."
MRI provides useful information regarding tumor characteristics, but if and how preoperative MRI improves prostate cancer surgery outcomes hasn't been examined. Cole and colleagues used Surveillance, Epidemiology, and End Results (SEER) data from 19,369 patients who underwent prostatectomy at one of 72 "hospital referral regions" between 2004 and 2015 to explore the question. The study cohort was older, with a mean patient age of 70 years.
Over the study time frame, the percentage of men receiving presurgical MRI increased 10-fold, from 2.9% to 28.2%. The group found that there were meaningful benefits to presurgical MRI, including lower odds of positive surgical margins (odds ratio, 0.84) and blood transfusions at 30 and 90 days postsurgery (odds ratio, 0.56 for 30 days and 0.58 for 90 days).
But despite the benefits of preoperative MRI for prostate surgery, there was a racial disparity regarding its use: Only 6.1% of Black men underwent the exam compared to 10.2% of their white counterparts. There was also a significant range in the use of presurgical MRI by geography, between 0% to 28.8%.
"Patients who received MRI were more likely to be white, married, and living within the hospital region in which they were treated," the authors explained. "Factors such as cost, health literacy, and availability of imaging may affect whether a man with prostate cancer receives an MRI."
The study results highlight the fact that what could be a valuable tool for improving prostate cancer surgery outcomes is not being used to its full advantage, according to the authors. To address this gap, Cole's team is developing a program called the Mass General Brigham Prostate Cancer Outreach Clinic in collaboration with Mass General Brigham's United Against Racism initiative.
"Although the trend in MRI usage is moving upwards, MRIs are still only used in a minority of men who are diagnosed with prostate cancer," Cole said in the Brigham statement. "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."
