To assess adoption of pre-biopsy prostate MRI in the United States and evaluate factors associated with MRI-Bx use. Prior reports have shown improved cancer detection with magnetic resonance image-guided prostate biopsies (MRI-Bx) vs. transrectal ultrasound-guided methods (TRUS-Bx). Population-based trends of their use and outcomes have not been previously characterized.
Using private insurance claims (2009-2015), we identified men who underwent prostate biopsy. Exposures were biopsy year and geographic region defined by metropolitan statistical area. Outcomes included biopsy type (MRI-Bx, TRUS-Bx, transperineal) based on procedure codes and cancer detection based on a new diagnosis for prostate cancer (ICD-9-CM 185). Hierarchical mixed-effects multivariable regression estimated odds of receiving MRI-Bx.
We identified 241,681 men (mean age 57.5±5.4 years) who underwent biopsy. MRI-Bx use rose rapidly (0.2% in 2009 to 6.5% in 2015, p<0.001). Overall, 3,429 men received MRI prior to biopsy, more commonly in metropolitan statistical areas (OR (odds ratio) 1.90, 95% CI 1.66-2.19). In 2015, nearly 18% of men with prior negative biopsy underwent a pre-biopsy MRI. Patients with prior negative biopsies were over four times more likely to receive MRI-guidance (vs. no prior, OR 4.63, 4.27-5.02) and had a greater chance of cancer detection with MRI-Bx (25.2% vs. 19.7% TRUS-Bx, p=0.010).
Among men undergoing prostate biopsy, pre-biopsy prostate MRI utilization was concentrated within urban areas and among patients with prior negative biopsies, where its use was associated with superior cancer detection compared to traditional TRUS-guided biopsies.
Urology. 2018 Apr 18 [Epub ahead of print]
Wen Liu, Dattatraya Patil, David H Howard, Renee Moore, Heqiong Wang, Martin G Sanda, Christopher P Filson
Emory University School of Medicine, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA., Department of Urology, Emory University School of Medicine, Atlanta, GA., Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA., Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA., Department of Urology, Emory University School of Medicine, Atlanta, GA; Atlanta Veterans Administration Medical Center, Decatur, GA. Electronic address: .