Prostate Magnetic Resonance Imaging Utilization and Its Relationship with Advanced Prostate Cancer Detection - Beyond the Abstract

In our recent study published in Urologic Oncology, we investigated the relationship between the increasing use of prostate MRI and the rising rates of advanced prostate cancer diagnoses.1 The study leveraged the SEER-Medicare database from 2004-2015, focusing on men over 65 diagnosed with localized prostate cancer. Our analysis revealed no significant association between regional prostate MRI utilization and the proportion of advanced prostate cancer cases. This finding challenges the hypothesis that the increase in advanced prostate cancer diagnoses is solely an artifact of improved imaging sensitivity.

Several factors may explain the observed trends. Notably, the 2012 United States Preventive Services Task Force (USPSTF) recommendation against routine PSA screening likely played a role. Studies have shown a significant decrease in PSA screening rates following this recommendation, particularly among younger men and certain racial/ethnic groups.2 This decrease in screening may have contributed to delayed diagnoses and a higher proportion of advanced-stage cancers at presentation.

While our study did not find a direct link between increased MRI use and advanced prostate cancer detection, it is important to acknowledge that MRI utilization was relatively low during the study period. As MRI technology continues to advance and its use becomes more widespread, the relationship between MRI and advanced prostate cancer detection may evolve. Continued monitoring of this association is warranted.

Our findings underscore the need for a nuanced understanding of the factors contributing to the rise in advanced prostate cancer diagnoses. While improved imaging techniques like MRI play a role in detection, other factors such as changes in screening practices and patient demographics must also be considered. A comprehensive approach that incorporates these various factors is crucial for developing effective screening and treatment strategies for prostate cancer.

Written by: Zhiyu Qian1 Yu-Jen Chen,2 Julia Feldman,1 Edoardo Beatrici,3 Dejan K. Filipas,4 Caroline M. Moore,5 Quoc-Dien Trinh,1 Adam S. Kibel,1 Stuart R. Lipsitz,6 Alexander P. Cole1

  1. Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 
  2. Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 
  3. Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Humanitas Research Hospital, Milan, Italy. 
  4. Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 
  5. University College London, London, UK. 
  6. Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 

References:

  1. Qian Z, Chen Y-J, Feldman J, et al. Prostate magnetic resonance imaging utilization and its relationship with advanced prostate cancer detection. Elsevier; 2024:
  2. Qian Z, Al Khatib K, Chen X, et al. Investigating the racial gap in prostate cancer screening with prostate-specific antigen among younger men from 2012 to 2020. JNCI Cancer Spectrum. 2023;7(2):pkad003.
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