Contemporary Trends in Magnetic Resonance Imaging at the Time of Prostate Biopsy: Results from a Large Private Insurance Database

Simon P. Kim, Robert Jeffrey Karnes, Raphael Mwangi, Holly Van Houten, Cary P. Gross, Boris Gershman, Michael S. Leapman, Nilay D Shah

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Abstract

Background: Magnetic resonance imaging (MRI) of the prostate (MRI-prostate) facilitates better detection of clinically significant prostate cancer (PCa). Yet, the national trends of MRI at the time of prostate biopsy and its ability to increase the detection of PCa in a biopsy-naïve population remain unknown. Objective: To elucidate the contemporary trends of MRI and prostate biopsy, and whether it improved PCa diagnosis among privately insured patients. Design, setting, and participants: This was a retrospective cohort study of a large private health insurance database in the USA—the OptumLabs Data Warehouse. We identified all men ≥40 yr of age who underwent index prostate biopsies from 2010 through 2016. Intervention: MRI-prostate at the time of index biopsy. Outcome measurements and statistical analysis: Utilization of the MRI at the time of biopsy and incident PCa diagnosis constituted the primary outcomes. We enumerated unadjusted and age-specific annual rates of MRI over time to elucidate trends using regression models (trend analysis). Bivariate and multivariable regression analyses identified patient characteristics associated with MRI-prostate, and the association between the use of MRI and PCa diagnosis. Results and limitations: Overall, 119 202 men underwent index prostate biopsies. Unadjusted annual rates of MRI at the time of biopsy significantly increased from 7 per 1000 biopsies in 2010 to 83 per 1000 biopsies in 2016 (p < 0.001 for trend). Age-specific rates increased across all age groups (40–49, 50–59, 60–65, 66–74, and 75+ yr; all p < 0.001). On multivariable analysis, black patients had a lower likelihood of MRI compared with white patients (odds ratio [OR]: 0.6; p < 0.01). MRI at the time of biopsy was not associated with a higher likelihood of incident PCa compared with traditional systematic biopsy (OR: 1.0; p = 0.7). The retrospective design and the inability to detect clinically significant PCa (Gleason 7+) constitute the limitations of this study. Conclusions: While the use of MRI at the time of biopsy rose markedly, it was not associated with a higher detection rate of PCa. Further research is needed to address effective dissemination of MRI and targeted biopsies, and racial disparities. Patient summary: From 2010 to 2016, our study found a significant rise in the utilization of magnetic resonance imaging of the prostate (MRI-prostate) at the time of index biopsy, although only a minority of patients undergo MRI-prostate. The use of MRI-prostate was not associated with a higher likelihood of diagnosing incident prostate cancer. In our contemporary cohort of privately insured patients screened for prostate cancer, utilization of magnetic resonance imaging (MRI) of the prostate increased markedly, but it did not improve the detection of prostate cancer. However, only a small number of patents undergo prostate MRI prior to biopsy, and racial disparities exist in its use.

Original languageEnglish (US)
JournalEuropean Urology Focus
DOIs
StatePublished - Jan 1 2019

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Insurance
Prostate
Magnetic Resonance Imaging
Databases
Biopsy
Prostatic Neoplasms
Odds Ratio
Patents
Health Insurance

Keywords

  • Biopsy
  • Magnetic resonance imaging
  • Prostate cancer

ASJC Scopus subject areas

  • Urology

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Contemporary Trends in Magnetic Resonance Imaging at the Time of Prostate Biopsy : Results from a Large Private Insurance Database. / Kim, Simon P.; Karnes, Robert Jeffrey; Mwangi, Raphael; Van Houten, Holly; Gross, Cary P.; Gershman, Boris; Leapman, Michael S.; Shah, Nilay D.

In: European Urology Focus, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Contemporary Trends in Magnetic Resonance Imaging at the Time of Prostate Biopsy: Results from a Large Private Insurance Database",
abstract = "Background: Magnetic resonance imaging (MRI) of the prostate (MRI-prostate) facilitates better detection of clinically significant prostate cancer (PCa). Yet, the national trends of MRI at the time of prostate biopsy and its ability to increase the detection of PCa in a biopsy-na{\"i}ve population remain unknown. Objective: To elucidate the contemporary trends of MRI and prostate biopsy, and whether it improved PCa diagnosis among privately insured patients. Design, setting, and participants: This was a retrospective cohort study of a large private health insurance database in the USA—the OptumLabs Data Warehouse. We identified all men ≥40 yr of age who underwent index prostate biopsies from 2010 through 2016. Intervention: MRI-prostate at the time of index biopsy. Outcome measurements and statistical analysis: Utilization of the MRI at the time of biopsy and incident PCa diagnosis constituted the primary outcomes. We enumerated unadjusted and age-specific annual rates of MRI over time to elucidate trends using regression models (trend analysis). Bivariate and multivariable regression analyses identified patient characteristics associated with MRI-prostate, and the association between the use of MRI and PCa diagnosis. Results and limitations: Overall, 119 202 men underwent index prostate biopsies. Unadjusted annual rates of MRI at the time of biopsy significantly increased from 7 per 1000 biopsies in 2010 to 83 per 1000 biopsies in 2016 (p < 0.001 for trend). Age-specific rates increased across all age groups (40–49, 50–59, 60–65, 66–74, and 75+ yr; all p < 0.001). On multivariable analysis, black patients had a lower likelihood of MRI compared with white patients (odds ratio [OR]: 0.6; p < 0.01). MRI at the time of biopsy was not associated with a higher likelihood of incident PCa compared with traditional systematic biopsy (OR: 1.0; p = 0.7). The retrospective design and the inability to detect clinically significant PCa (Gleason 7+) constitute the limitations of this study. Conclusions: While the use of MRI at the time of biopsy rose markedly, it was not associated with a higher detection rate of PCa. Further research is needed to address effective dissemination of MRI and targeted biopsies, and racial disparities. Patient summary: From 2010 to 2016, our study found a significant rise in the utilization of magnetic resonance imaging of the prostate (MRI-prostate) at the time of index biopsy, although only a minority of patients undergo MRI-prostate. The use of MRI-prostate was not associated with a higher likelihood of diagnosing incident prostate cancer. In our contemporary cohort of privately insured patients screened for prostate cancer, utilization of magnetic resonance imaging (MRI) of the prostate increased markedly, but it did not improve the detection of prostate cancer. However, only a small number of patents undergo prostate MRI prior to biopsy, and racial disparities exist in its use.",
keywords = "Biopsy, Magnetic resonance imaging, Prostate cancer",
author = "Kim, {Simon P.} and Karnes, {Robert Jeffrey} and Raphael Mwangi and {Van Houten}, Holly and Gross, {Cary P.} and Boris Gershman and Leapman, {Michael S.} and Shah, {Nilay D}",
year = "2019",
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language = "English (US)",
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T1 - Contemporary Trends in Magnetic Resonance Imaging at the Time of Prostate Biopsy

T2 - Results from a Large Private Insurance Database

AU - Kim, Simon P.

AU - Karnes, Robert Jeffrey

AU - Mwangi, Raphael

AU - Van Houten, Holly

AU - Gross, Cary P.

AU - Gershman, Boris

AU - Leapman, Michael S.

AU - Shah, Nilay D

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Magnetic resonance imaging (MRI) of the prostate (MRI-prostate) facilitates better detection of clinically significant prostate cancer (PCa). Yet, the national trends of MRI at the time of prostate biopsy and its ability to increase the detection of PCa in a biopsy-naïve population remain unknown. Objective: To elucidate the contemporary trends of MRI and prostate biopsy, and whether it improved PCa diagnosis among privately insured patients. Design, setting, and participants: This was a retrospective cohort study of a large private health insurance database in the USA—the OptumLabs Data Warehouse. We identified all men ≥40 yr of age who underwent index prostate biopsies from 2010 through 2016. Intervention: MRI-prostate at the time of index biopsy. Outcome measurements and statistical analysis: Utilization of the MRI at the time of biopsy and incident PCa diagnosis constituted the primary outcomes. We enumerated unadjusted and age-specific annual rates of MRI over time to elucidate trends using regression models (trend analysis). Bivariate and multivariable regression analyses identified patient characteristics associated with MRI-prostate, and the association between the use of MRI and PCa diagnosis. Results and limitations: Overall, 119 202 men underwent index prostate biopsies. Unadjusted annual rates of MRI at the time of biopsy significantly increased from 7 per 1000 biopsies in 2010 to 83 per 1000 biopsies in 2016 (p < 0.001 for trend). Age-specific rates increased across all age groups (40–49, 50–59, 60–65, 66–74, and 75+ yr; all p < 0.001). On multivariable analysis, black patients had a lower likelihood of MRI compared with white patients (odds ratio [OR]: 0.6; p < 0.01). MRI at the time of biopsy was not associated with a higher likelihood of incident PCa compared with traditional systematic biopsy (OR: 1.0; p = 0.7). The retrospective design and the inability to detect clinically significant PCa (Gleason 7+) constitute the limitations of this study. Conclusions: While the use of MRI at the time of biopsy rose markedly, it was not associated with a higher detection rate of PCa. Further research is needed to address effective dissemination of MRI and targeted biopsies, and racial disparities. Patient summary: From 2010 to 2016, our study found a significant rise in the utilization of magnetic resonance imaging of the prostate (MRI-prostate) at the time of index biopsy, although only a minority of patients undergo MRI-prostate. The use of MRI-prostate was not associated with a higher likelihood of diagnosing incident prostate cancer. In our contemporary cohort of privately insured patients screened for prostate cancer, utilization of magnetic resonance imaging (MRI) of the prostate increased markedly, but it did not improve the detection of prostate cancer. However, only a small number of patents undergo prostate MRI prior to biopsy, and racial disparities exist in its use.

AB - Background: Magnetic resonance imaging (MRI) of the prostate (MRI-prostate) facilitates better detection of clinically significant prostate cancer (PCa). Yet, the national trends of MRI at the time of prostate biopsy and its ability to increase the detection of PCa in a biopsy-naïve population remain unknown. Objective: To elucidate the contemporary trends of MRI and prostate biopsy, and whether it improved PCa diagnosis among privately insured patients. Design, setting, and participants: This was a retrospective cohort study of a large private health insurance database in the USA—the OptumLabs Data Warehouse. We identified all men ≥40 yr of age who underwent index prostate biopsies from 2010 through 2016. Intervention: MRI-prostate at the time of index biopsy. Outcome measurements and statistical analysis: Utilization of the MRI at the time of biopsy and incident PCa diagnosis constituted the primary outcomes. We enumerated unadjusted and age-specific annual rates of MRI over time to elucidate trends using regression models (trend analysis). Bivariate and multivariable regression analyses identified patient characteristics associated with MRI-prostate, and the association between the use of MRI and PCa diagnosis. Results and limitations: Overall, 119 202 men underwent index prostate biopsies. Unadjusted annual rates of MRI at the time of biopsy significantly increased from 7 per 1000 biopsies in 2010 to 83 per 1000 biopsies in 2016 (p < 0.001 for trend). Age-specific rates increased across all age groups (40–49, 50–59, 60–65, 66–74, and 75+ yr; all p < 0.001). On multivariable analysis, black patients had a lower likelihood of MRI compared with white patients (odds ratio [OR]: 0.6; p < 0.01). MRI at the time of biopsy was not associated with a higher likelihood of incident PCa compared with traditional systematic biopsy (OR: 1.0; p = 0.7). The retrospective design and the inability to detect clinically significant PCa (Gleason 7+) constitute the limitations of this study. Conclusions: While the use of MRI at the time of biopsy rose markedly, it was not associated with a higher detection rate of PCa. Further research is needed to address effective dissemination of MRI and targeted biopsies, and racial disparities. Patient summary: From 2010 to 2016, our study found a significant rise in the utilization of magnetic resonance imaging of the prostate (MRI-prostate) at the time of index biopsy, although only a minority of patients undergo MRI-prostate. The use of MRI-prostate was not associated with a higher likelihood of diagnosing incident prostate cancer. In our contemporary cohort of privately insured patients screened for prostate cancer, utilization of magnetic resonance imaging (MRI) of the prostate increased markedly, but it did not improve the detection of prostate cancer. However, only a small number of patents undergo prostate MRI prior to biopsy, and racial disparities exist in its use.

KW - Biopsy

KW - Magnetic resonance imaging

KW - Prostate cancer

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