OncologyIncreasing Utilization of Multiparametric Magnetic Resonance Imaging in Prostate Cancer Active Surveillance
Section snippets
Study Population
The SEER-Medicare data files were used to identify men with nonmanaged care Medicare coverage age 66 years or older, and localized prostate (International Classification of Diseases ninth Edition code 185) between 2008 and 2013. Methods for cohort identification closely adhered to prior work using SEER-Medicare data to study prostate cancer active surveillance.11 We included patients 66 years or older who were continuously enrolled in Medicare Parts A and B during the 12 months prior and after
Results
We identified 9467 male Medicare beneficiaries diagnosed with prostate cancer and managed with active surveillance between 2008 and 2013. Of these, 1289 (14%) received mpMRI. The demographic, socioeconomic, and clinical information for the men in the prostate cancer surveillance cohort is summarized in Table 1. Overall, most of the men in the cohort were under 75 years, white, married, had low comorbidity burden, Gleason score 3 + 3, lived in higher educational attainment areas, higher income
Discussion
In this population-based study we characterize patterns of mpMRI utilization for men on surveillance for localized prostate cancer between 2008 and 2013. There are several key implications from this analysis. First, mpMRI was uncommon, with only 14% of men on surveillance receiving mpMRI. Second, the uptake of mpMRI in active surveillance was relatively slow with an increase of only 3.7% over the 5 years analyzed. Finally, use of mpMRI varied significantly across geographic regions and among
Conclusion
From 2008 to 2013, the use of mpMRI in prostate cancer active surveillance in the Medicare population increased incrementally, but significantly. The overall rate of mpMRI use was 14% and increased by a mere 3.7% over the 5 years analyzed. Receipt of mpMRI among men on surveillance for prostate cancer varied significantly across demographic and socioeconomic strata. This may represent provider uncertainty and access disparities and is a potential target for future work determining ideal
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2021, Value in Health Regional IssuesCitation Excerpt :The introduction of periodically MRI, however, has been supported in the literature,50-53 as seen in the National Collaborating Center of Cancer–National Institute for Health and Care Excellence (NICE) in the United Kingdom,54 with the advantage of more accurately monitoring PCa patients, despite a modest increase in spending.55 To date, there is considerable amount of published evidences of mpMRI benefits in the selection and monitoring of AS patients,56-59 but few studies supporting rebiopsy replacement by this imaging method.60,61 The present study was carried out in the city of Sao Paulo, the largest economic center in the country, reaching the population of the metropolitan region that covers almost 10% of the total Brazilian population (Brazil = 211 million inhabitants/Sao Paulo = 21.9 million inhabitants).28
Funding/Disclosures: Mina M. Fam is supported in part by the Shadyside Hospital Foundation. Liam C. Macleod is supported in part by the Shadyside Hospital Foundation and in part by the Conquer Cancer Foundation. Bruce L. Jacobs is supported in part by the University of Pittsburgh Physicians Academic Foundation, P30CA047904 from the National Cancer Institute and the Henry L. Hillman Foundation.
The other authors declare no conflict of interest.