Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Clinical Research
  • Published:

Racial disparity in the utilization of multiparametric MRI–ultrasound fusion biopsy for the detection of prostate cancer

Prostate Cancer and Prostatic Diseases volume 23, pages 567–572 (2020)Cite this article

Subjects

Abstract

Background

Black men have significantly higher incidence and are up to three times more likely to die of prostate cancer (PCa) than White men. Multiparametric magnetic resonance imaging-ultrasound fusion biopsy (FBx) has emerged as a promising modality for the detection of PCa. The goal of our study is to identify differences in utilization of FBx between Black and White men presenting with suspicion of PCa.

Methods

We performed a retrospective review of Black and White men who presented with suspicion of PCa and required biopsy from January 2014 to December 2018. Multivariate logistic regression analysis was done to study the influence of race on the utilization of FBx.

Results

Six hundred nineteen (Black: 182, White: 437) men were included in the study. Forty-one out of 182 (22.5%) Black men underwent FBx compared with 225/437 (51.5%) of White men (P < 0.001). After adjusting for age, race, prostate-specific antigen level, digital rectal exam, family history of PCa and health insurance provider, Black race was found to be a significant negative predictor of obtaining FBx (OR:0.32, 95% CI: 0.21–0.51, P < 0.001). Black race stayed an independent negative predictor (OR: 0.36, 95% CI: 0.20–0.64, P < 0.001) in the cohort of patients who were biopsy naïve; however, although reduced, there was no significant difference in the cohort with a prior negative biopsy (OR: 0.51, 95% CI: 0.19–1.36, P = 0.179).

Conclusions

Although FBx is a superior modality for early detection of PCa, we found that Black men were less likely to undergo FBx when presenting with PCa suspicion. Further investigation is needed to evaluate if this difference is patient preference or if there are underlying socioeconomic, cultural or provider biases influencing this disparity.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Study population inclusion and exclusion criteria.

Similar content being viewed by others

References

  1. Sonn GA, Chang E, Natarajan S, Margolis DJ, Macairan M, Lieu P, et al. Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen. Eur Urol. 2014;65:809–15.

    Article  Google Scholar 

  2. Mohler JL, Antonarakis ES. NCCN guidelines updates: management of prostate cancer. J Natl Compr Cancer Netw. 2019;17:583–6.

    Google Scholar 

  3. Rosenkrantz AB, Verma S, Choyke P, Eberhardt SC, Eggener SE, Gaitonde K, et al. Prostate magnetic resonance imaging and magnetic resonance imaging targeted biopsy in patients with a prior negative biopsy: a consensus statement by AUA and SAR. J Urol. 2016;196:1613–18. https://doi.org/10.1016/j.juro.2016.06.079.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hoffman RM, Gilliland FD, Eley JW, Harlan LC, Stephenson RA, Stanford JL, et al. Racial and ethnic differences in advanced-stage prostate cancer: the prostate cancer outcomes study. J Natl Cancer Inst. 2001;93:388–95.

    Article  CAS  Google Scholar 

  5. Shin T, Smyth TB, Ukimura O, de Castro Abreu AL, Oishi M, Mimata H, et al. Detection of prostate cancer using magnetic resonance imaging/ultrasonography image-fusion targeted biopsy in African-American men. BJU Int. 2017;120:233–8.

  6. Mahal BA, Berman RA, Taplin ME, Huang FW. Prostate cancer-specific mortality across gleason scores in black vs nonblack men. JAMA 2018;320:2479–81.

    Article  Google Scholar 

  7. Mahal BA, Alshalalfa M, Spratt DE, Davicioni E, Zhao SG, Feng FY, et al. Prostate cancer genomic-risk differences between African-American and white men across Gleason scores. Eur Urol. 2019;75:1038–40.

    Article  Google Scholar 

  8. Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, et al. SEER Cancer Statistics Review, 1975-2016, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2016/, based on November 2018 SEER data submission, posted to the SEER web site, April 2019.

  9. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. PI-RADS prostate imaging-reporting and data system: 2015, version 2. Eur Urol. 2016;69:16–40.

    Article  Google Scholar 

  10. DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA Cancer J Clin. 2019;69:211–33.

    Article  Google Scholar 

  11. Sidana A, Watson MJ, George AK, Rastinehad AR, Vourganti S, Rais-Bahrami S, et al. Fusion prostate biopsy outperforms 12-core systematic prostate biopsy in patients with prior negative systematic biopsy: a multi-institutional analysis. Urol Oncol. 2018;36:341.e1–341.e7.

    Article  Google Scholar 

  12. Fulgham PF, Rukstalis DB, Turkbey IB, Rubenstein JN, Taneja S, Carroll PR, et al. AUA policy statement on the use of multiparametric magnetic resonance imaging in the diagnosis, staging and management of prostate cancer. J Urol. 2017;198:832–8.

    Article  Google Scholar 

  13. Bjurlin MA, Carroll PR, Eggener S, Fulgham PF, Margolis DJ, Pinto PA, et al. Update of the standard operating procedure on the use of multiparametric magnetic resonance imaging for the diagnosis, staging and management of prostate cancer. J Urol. 2019; 101097JU0000000000000617.

  14. Krimphove MJ, Cole AP, Fletcher SA, Harmouch SS, Berg S, Lipsitz SR, et al. Evaluation of the contribution of demographics, access to health care, treatment, and tumor characteristics to racial differences in survival of advanced prostate cancer. Prostate Cancer Prostatic Dis. 2019;22:125–36. https://doi.org/10.1038/s41391-018-0083-4.

    Article  PubMed  Google Scholar 

  15. Dess RT, Hartman HE, Mahal BA, Soni PD, Jackson WC, Cooperberg MR, et al. Association of black race with prostate cancer-specific and other-cause mortality. JAMA Oncol. 2019;5:975–83.

    Article  Google Scholar 

  16. Han PK, Kobrin S, Breen N, Joseph DA, Li J, Forsch DL, et al. National evidence on the use of shared decision making in prostate-specific antigen screening. Ann Fam Med. 2013;11:306–14.

    Article  Google Scholar 

  17. Hoffman RM. Clinical practice. Screening for prostate cancer. N. Engl J Med. 2011;365:2013–9.

    Article  CAS  Google Scholar 

  18. Kennedy BR, Mathis CC, Woods AK. African Americans and their distrust of the health care system: healthcare for diverse populations. J Cult Divers. 2007;14:56–60.

    PubMed  Google Scholar 

  19. Jacobs EA, Rolle I, Ferrans CE, Whitaker EE, Warnecke RB. Understanding African Americans’ views of the trustworthiness of physicians. J Gen Intern Med. 2006;21:642–7.

    Article  Google Scholar 

  20. Armstrong K, McMurphy S, Dean L, Micco E, Putt M, Halbert CH, et al. Differences in the patterns of healthcare system distrust between blacks and whites. J Gen Intern Med. 2008;23:827.

    Article  Google Scholar 

  21. Halbert CH, Weathers B, Belmoor E, Mahler B, Coyne J, Thompson HS, et al. Racial differences in medical mistrust among men diagnosed with prostate cancer. Cancer. 2009;115:2553–61. https://doi.org/10.1002/cncr.24249

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bustillo NE, McGinty HL, Dahn JR, Yanez B, Antoni MH, Kava BR, et al. Fatalism, medical mistrust and pretreatment health-related quality of life in ethnically diverse prostate cancer patients. Psychooncology 2017;26:323–9. https://doi.org/10.1002/pon.4030

    Article  PubMed  Google Scholar 

  23. Moore AD, Hamilton JB, Knafl GJ, Godley PA, Carpenter WR, Bensen JT, et al. The influence of mistrust, racism, religious participation, and access to care on patient satisfaction for African American men: the North Carolina-Louisiana Prostate Cancer Project. J Natl Med Assoc 2013;105:59–68. Spring

    Article  Google Scholar 

  24. Pietro GD, Chornokur G, Kumar NB, Davis C, Park JY. Racial differences in the diagnosis and treatment of prostate cancer. Int Neurourol J. 2016;20 Suppl 2:S112–S119. https://doi.org/10.5213/inj.1632722.361.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Bhuyan SS, Chandak A, Gupta N, Isharwal S, LaGrange C, Mahmood A, et al. Patient-provider communication about prostate cancer screening and treatment: new evidence from the Health Information National Trends Survey. Am J Mens Health. 2017;11:134–46. https://doi.org/10.1177/1557988315614082.

    Article  PubMed  Google Scholar 

  26. Altonji JG, Doraszelski U, Segal L. Black/white differences in wealth. Econ Perspect. 2000;24:38–50.

    Google Scholar 

  27. Arroyo-Johnson C, Mincey KD. Obesity epidemiology worldwide. Gastroenterol Clin North Am. 2016;45:571–9. https://doi.org/10.1016/j.gtc.2016.07.012

    Article  PubMed  PubMed Central  Google Scholar 

  28. Raley RK, Sweeney MM, Wondra D. The growing racial and ethnic divide in U.S. marriage patterns. Future Child. 2015;25:89–109.

    Article  Google Scholar 

  29. Arnett MJ, Thorpe RJ Jr, Gaskin DJ, Bowie JV, LaVeist TA. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93:456–67. https://doi.org/10.1007/s11524-016-0054-9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Tehranifar P, Neugut AI, Phelan JC, Link BG, Liao Y, Desai M, et al. Medical advances and racial/ethnic disparities in cancer survival. Cancer Epidemiol Biomark Prev. 2009;18:2701–8. https://doi.org/10.1158/1055-9965.EPI-09-0305

    Article  Google Scholar 

  31. Sabin J, Nosek BA, Greenwald A, Rivara FP. Physicians’ implicit and explicit attitudes about race by MD race, ethnicity, and gender. J Health Care Poor Underserved. 2009;20:896–913. https://doi.org/10.1353/hpu.0.0185.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;105:e60–e76. https://doi.org/10.2105/AJPH.2015.302903

    Article  PubMed  PubMed Central  Google Scholar 

  33. Penner LA, Dovidio JF, Gonzalez R, Albrecht TL, Chapman R, Foster T, et al. The effects of oncologist implicit racial bias in racially discordant oncology interactions. J Clin Oncol. 2016;34:2874–80. https://doi.org/10.1200/JCO.2015.66.3658.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Connor Hoge, Daniel J. Lama, Ilana Bergelson, Monzer Haj-Hamed, Sean Maynor, Krishnanath Gaitonde & Abhinav Sidana

  2. Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Sadhna Verma

Authors
  1. Connor Hoge
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sadhna Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel J. Lama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ilana Bergelson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Monzer Haj-Hamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sean Maynor
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Krishnanath Gaitonde
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Abhinav Sidana
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abhinav Sidana.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hoge, C., Verma, S., Lama, D.J. et al. Racial disparity in the utilization of multiparametric MRI–ultrasound fusion biopsy for the detection of prostate cancer. Prostate Cancer Prostatic Dis 23, 567–572 (2020). https://doi.org/10.1038/s41391-020-0223-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41391-020-0223-5

This article is cited by

Search

Advanced search

Quick links