Purpose

We characterized population-level cancer-specific outcomes for prostate cancer patients based on use of prebiopsy prostate MRI.

Methods

Using SEER-Medicare claims, we identified men diagnosed with localized prostate cancer from 2010–2015 and prostate-specific antigen (PSA) < 20 ng/mL. Primary exposure was prebiopsy prostate MRI prior to diagnosis (i.e., CPT 72197 linked to urology-specific diagnosis). Outcomes included diagnosis of Grade Group 2+ disease on biopsy and proportion treated with prostatectomy. We assessed those treated with prostatectomy and evaluated association with prebiopsy MRI and grade concordance between biopsy and prostatectomy. We estimated adjusted odds ratios with multivariable regression after accounting for other factors (e.g., age, year, PSA, race/ethnicity).

Results

We identified 48,574 patients, where 915 (1.9%) underwent prebiopsy MRI. Patients with prebiopsy MRI had more GG>2 cancer on biopsy (70.0% MRI vs. 62.8% no MRI) but lost significance after adjustment (OR 1.12, 95% CI 0.96–1.30). Patients with prebiopsy MRI were more likely to have prostatectomy (39.2% vs. 28.5%, adjusted OR 1.51, 95%CI 1.31–1.76). Downgrading from biopsy GG 3–5 to final GG 1–2 was less common after prebiopsy MRI (21.3% vs. 28.2% no MRI, P = 0.05) but not significant after adjustment (OR 0.74, 95% CI 0.51 – 1.08). Among 14,027 men with prostatectomy, accurate risk classification was not more likely with a prebiopsy MRI (48.0% no MRI vs. 49.6% prebiopsy MRI, P = 0.56).

Conclusion

During initial adoption, men with prebiopsy prostate MRI had marginally increased detection of significant cancer on biopsy and were more likely to be treated with prostatectomy. For those treated with prostatectomy, use of prebiopsy MRI was not associated with a greater likelihood of accurate risk classification or grade concordance between biopsy and final pathology results.

中文翻译：

---

进行活检前前列腺 MRI 的前列腺癌患者的癌症特异性结果

 目的

我们根据活检前前列腺 MRI 的使用，描述了前列腺癌患者的人群水平癌症特异性结果。

 方法

利用 SEER-Medicare 声明，我们确定了 2010 年至 2015 年诊断患有局限性前列腺癌且前列腺特异性抗原 (PSA) < 20 ng/mL 的男性。主要暴露是诊断前的活检前前列腺 MRI（即 CPT 72197 与泌尿科特异性诊断相关）。结果包括活检诊断为 2+ 级疾病以及接受前列腺切除术治疗的比例。我们评估了接受前列腺切除术治疗的患者，并评估了与活检前 MRI 的关联以及活检和前列腺切除术之间的分级一致性。在考虑其他因素（例如年龄、年份、PSA、种族/民族）后，我们利用多变量回归估计了调整后的优势比。

 结果

我们确定了 48,574 名患者，其中 915 名 (1.9%) 接受了活检前 MRI。活检前进行 MRI 的患者在活检时有更多的 GG>2 癌症（70.0% MRI 对比 62.8% 无 MRI），但调整后显着性降低（OR 1.12，95% CI 0.96–1.30）。活检前 MRI 的患者更有可能接受前列腺切除术（39.2% vs. 28.5%，调整后 OR 1.51，95%CI 1.31–1.76）。活检前 MRI 后，从活检 GG 3-5 降级至最终 GG 1-2 的情况较少见（21.3% 对比无 MRI 的 28.2%， P = 0.05），但调整后不显着（OR 0.74，95% CI 0.51 – 1.08）。在 14,027 名接受前列腺切除术的男性中，活检前 MRI 并不更有可能进行准确的风险分类（48.0% 无 MRI 对比 49.6% 活检前 MRI， P = 0.56）。

 结论

在最初采用期间，进行活检前前列腺 MRI 的男性在活检中显着癌症的检出率略有增加，并且更有可能接受前列腺切除术治疗。对于接受前列腺切除术治疗的患者，活检前 MRI 的使用与准确风险分类或活检和最终病理结果之间的分级一致性的可能性更大无关。