Imaging techniques are important tools in cancer diagnosis and treatment, but their use remains limited in prostate cancer patients. Systematic prostate biopsies are often used to locate cancerous tissue and guide treatment. While magnetic resonance imaging (MRI) can yield greater insight into tumor characteristics, the extent to which it improves treatment outcomes has not been explored on a national scale. Using a population-based cancer registry linked to Medicare claims, researchers from Brigham and Women’s Hospital and collaborators examined the association between preoperative MRI usage and surgical outcomes in 19,369 prostatectomy patients from 2004-2015. Their research, published in The Journal of Urology, demonstrates that MRI may significantly reduce postoperative complications, but that it remains under-utilized in many areas of the United States, with only 6.1 percent of Black patients receiving preoperative MRIs compared to 10.2 percent of white patients.

“Overdiagnosis, overtreatment and toxicity associated with treatment are big problems with prostate cancer, but MRI can help reduce unnecessary biopsies and improve surgical outcomes,” said corresponding author Alexander Cole, MD, of the Brigham’s Division of Urology. “While MRI is a tool that is changing the diagnosis and treatment of prostate cancer, our work shows that the chance of getting a preoperative prostate MRI varies significantly depending on where you happen to be living, what race you are, and on what year you were diagnosed.”

In analyzing Medicare claims linked to the Surveillance, Epidemiology, and End Results (SEER) database, a cancer registry representative of the United States population, the study authors found significant postoperative benefits for patients who received MRI. They identified a reduced likelihood that cancerous cells may remain in the patient after the operation (a “positive surgical margin”) and reduced odds of blood transfusions at 30 and 90 days after the operation. Notably, the researchers found that preoperative MRI was associated with higher likelihood of further treatment, but they hypothesize that MRI may be associated with more resource-intensive cancer care overall.
While the proportion of prostatectomy patients receiving preoperative MRI increased over the study period nearly tenfold, from 2.9 percent to 28.2 percent, the use of MRI in different regional health care markets varied widely, ranging from 0 to 28.8 percent. Patients who received MRI were more likely to be white, married and living within the hospital region in which they were treated. Factors such as cost, health literacy and availability of imaging may affect whether a man with prostate cancer receives an MRI, according to Cole.

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