Increasing Utilization of Multiparametric Magnetic Resonance Imaging in Prostate Cancer Active Surveillance



      To characterize the use of multiparametric magnetic resonance imaging (mpMRI) in male Medicare beneficiaries electing active surveillance for prostate cancer. mpMRI has emerged as a tool that may improve risk-stratification and decrease repeated biopsies in men electing active surveillance. However, the extent to which mpMRI has been implemented in active surveillance has not been established.


      Using Surveillance, Epidemiology, and End Results registry data linked to Medicare claims data, we identified men with localized prostate cancer diagnosed between 2008 and 2013 and managed with active surveillance. We classified men into 2 treatment groups: active surveillance without mpMRI and active surveillance with mpMRI. We then fit a multivariable logistic regression models to examine changing mpMRI utilization over time, and factors associated with the receipt of mpMRI.


      We identified 9467 men on active surveillance. Of these, 8178 (86%) did not receive mpMRI and 1289 (14%) received mpMRI. The likelihood of receiving mpMRI over the entire study period increased by 3.7% (P = .004). On multivariable logistic regression, patients who were younger, white, had lower comorbidity burden, lived in the northeast and west, had higher incomes and lived in more urban areas had greater odds of receiving mpMRI (all P < .05).


      From 2008 to 2013, use of mpMRI in active surveillance increased gradually but significantly. Receipt of mpMRI among men on surveillance for prostate cancer varied significantly across demographic, geographic, and socioeconomic strata. Going forward, studies should investigate causes for this variation and define ideal strategies for equitable, cost-effective dissemination of mpMRI technology.
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        • Futterer J.J.
        • Briganti A.
        • De Visschere P.
        • et al.
        Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature.
        European urology. 2015; 68: 1045-1053
        • Cucchiara V.
        • Cooperberg M.R.
        • Dall'Era M.
        • et al.
        Genomic markers in prostate cancer decision making.
        Eur Urol. 2018; 73: 572-582
        • Bryant R.J.
        • Yang B.
        • Philippou Y.
        • et al.
        Does the introduction of prostate multiparametric magnetic resonance imaging into the active surveillance protocol for localized prostate cancer improve patient re-classification?.
        BJU Int. 2018;
        • Perlis N.
        • Al-Kasab T.
        • Ahmad A.
        • et al.
        Defining a cohort that may not require repeat prostate biopsy based on PCA3 score and magnetic resonance imaging: the dual negative effect.
        J Urol. 2018; 199: 1182-1187
        • Curci N.E.
        • Lane B.R.
        • Shankar P.R.
        • et al.
        Integration and diagnostic accuracy of 3T nonendorectal coil prostate magnetic resonance imaging in the context of active surveillance.
        Urology. 2018; 116: 137-143
        • Sherrer R.L.
        • Lai W.S.
        • Thomas J.V.
        • Nix J.W.
        • Rais-Bahrami S.
        Incidental findings on multiparametric MRI performed for evaluation of prostate cancer.
        Abdom Radiol. 2018; 43: 696-701
        • Johnston E.
        • Pye H.
        • Bonet-Carne E.
        • et al.
        INNOVATE: A prospective cohort study combining serum and urinary biomarkers with novel diffusion-weighted magnetic resonance imaging for the prediction and characterization of prostate cancer.
        BMC Cancer. 2016; 16: 816
        • Muthigi A.
        • Sidana A.
        • George A.K.
        • et al.
        Current beliefs and practice patterns among urologists regarding prostate magnetic resonance imaging and magnetic resonance-targeted biopsy.
        Urol Oncol. 2017; 35: 32, e31-e37
        • Wennberg J.
        • Gittelsohn
        Small area variations in health care delivery.
        Science. 1973; 182: 1102-1108
        • Cary K.C.
        • Punnen S.
        • Odisho A.Y.
        • et al.
        Nationally representative trends and geographic variation in treatment of localized prostate cancer: the Urologic Diseases in America project.
        Prostate Cancer Prostatic Dis. 2015; 18: 149-154
        • Filson C.P.
        • Schroeck F.R.
        • Ye Z.
        • Wei J.T.
        • Hollenbeck B.K.
        • Miller D.C.
        Variation in use of active surveillance among men undergoing expectant treatment for early stage prostate cancer.
        J Urol. 2014; 192: 75-80
        • Modi P.K.
        • Kaufman S.R.
        • Qi J.
        • et al.
        National trends in active surveillance for prostate cancer: validation of Medicare claims-based algorithms.
        Urology. 2018;
        • Carroll P.H.
        • Mohler J.L.
        NCCN guidelines updates: prostate cancer and prostate cancer early detection.
        J Natl Compr Cancer Netw. 2018; 16: 620-623
        • Epstein J.I.
        • Allsbrook W.C.Jr.
        • Amin M.B.
        • Egevad L.L.
        • Committee I.G.
        The 2005 International Society of Urological Pathology (ISUP) Consensus conference on Gleason grading of prostatic carcinoma.
        Am J Surg Pathol. 2005; 29: 1228-1242
        • Klabunde C.N.
        • Potosky A.L.
        • Legler J.M.
        • Warren J.L.
        Development of a comorbidity index using physician claims data.
        J Clin Epidemiol. 2000; 53: 1258-1267
      1. Wickham H., Francois R., Henry L., Müller K. dplyr: a grammar of data manipulation. R package version 0.7.4.

      2. Subirana I., Sanz H., Vila J. Building Bivariate Tables: The compareGroups Package for R. J Stat Softw, 57:1-16.

        • Hadley W.
        Springer Science+Business Media, LLC, New York, NY2016
        • Ahmed H.U.
        • El-Shater Bosaily A.
        • Brown L.C.
        • et al.
        Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study.
        Lancet. 2017; 389: 815-822
        • Dickinson L.
        • Ahmed H.U.
        • Allen C.
        • et al.
        Scoring systems used for the interpretation and reporting of multiparametric MRI for prostate cancer detection, localization, and characterization: could standardization lead to improved utilization of imaging within the diagnostic pathway?.
        J Magn Reson Imaging. 2013; 37: 48-58
        • Barentsz J.O.
        • Richenberg J.
        • Clements R.
        • et al.
        ESUR prostate MR guidelines 2012.
        Eur Radiol. 2012; 22: 746-757
        • Vargas H.A.
        • Hotker A.M.
        • Goldman D.A.
        • et al.
        Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference.
        Eur Radiol. 2016; 26: 1606-1612
        • Turkbey B.
        • Brown A.M.
        • Sankineni S.
        • Wood B.J.
        • Pinto P.A.
        • Choyke P.L.
        Multiparametric prostate magnetic resonance imaging in the evaluation of prostate cancer.
        CA Cancer J Clin. 2016; 66: 326-336
        • Marks L.
        • Young S.
        • Natarajan S.
        MRI-ultrasound fusion for guidance of targeted prostate biopsy.
        Curr Opin Urol. 2013; 23: 43-50
        • Sonn G.A.
        • Natarajan S.
        • Margolis D.J.
        • et al.
        Targeted biopsy in the detection of prostate cancer using an office based magnetic resonance ultrasound fusion device.
        J Urol. 2013; 189: 86-91
        • Arsov C.
        • Rabenalt R.
        • Quentin M.
        • et al.
        Comparison of patient comfort between MR-guided in-bore and MRI/ultrasound fusion-guided prostate biopsies within a prospective randomized trial.
        World J Urol. 2016; 34: 215-220
        • Halpern J.A.
        • Sedrakyan A.
        • Hsu W.C.
        • et al.
        Use, complications, and costs of stereotactic body radiotherapy for localized prostate cancer.
        Cancer. 2016; 122: 2496-2504
        • Gokce M.I.
        • Sundi D.
        • Schaeffer E.
        • Pettaway C.
        Is active surveillance a suitable option for African American men with prostate cancer? A systemic literature review.
        Prostate Cancer Prostatic Dis. 2017; 20: 127-136
        • Adler J.T.
        • Chang D.C.
        Implications of market competition, technology adoption, and cost for surgical patients.
        JAMA Surg. 2016; 151: 621