Objective
To assess adoption of prebiopsy prostate magnetic resonance imaging (MRI) in the United
States and to evaluate factors associated with magnetic resonance imaging-guided prostate
biopsy (MRI-Bx) use. Prior reports have shown improved cancer detection with MRI-Bx
vs transrectal ultrasound-guided methods (transrectal ultrasound-guided biopsy [TRUS-Bx]).
Population-based trends of their use and outcomes have not been previously characterized.
Materials and Methods
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, or transperineal biopsy) based
on procedure codes and cancer detection based on a new diagnosis for prostate cancer
(International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]
185). Hierarchical mixed-effects multivariable regression estimated odds of undergoing
MRI-Bx.
Results
We identified 241,681 men (mean age 57.5 ± 5.4 years) who underwent biopsy. The use
of MRI-Bx rose rapidly (0.2% in 2009 to 6.5% in 2015, P <.001). Overall, 3429 men underwent MRI before biopsy, more commonly in metropolitan
statistical areas (odds ratio 1.90, 95% confidence interval 1.66-2.19). In 2015, nearly
18% of men with prior negative biopsy underwent a prebiopsy MRI. Patients with prior
negative biopsies were over 4 times more likely to use MRI guidance (vs no prior biopsies,
odds ratio 4.63, 95% confidence interval 4.27-5.02) and had a greater chance of cancer
detection with MRI-Bx (25.2%) vs TRUS-Bx (19.7%, P = .010).
Conclusion
Among men undergoing prostate biopsy, prebiopsy 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 with traditional TRUS-Bx.
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Article info
Publication history
Published online: April 18, 2018
Accepted:
April 5,
2018
Received:
January 23,
2018
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: This study was supported by a Winship Cancer Institute Prostate Cancer Pilot Grant (CPF).
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
