Study unearths significant disparities in use of prostate MRI after an elevated PSA blood test

Asian, Black and Latino men are significantly less likely to undergo prostate MRI after elevated blood test results, according to new research published Monday in JAMA Network Open.

Previous studies have demonstrated disparities in treating the disease, with minority patients facing lower odds of receiving proper prostate-specific antigen screening or other follow-up services. Magnetic resonance imaging has emerged more recently as a tool to further assess men with elevated PSA prior to potentially unnecessary prostate biopsies.

Wanting to better understand MRI use among different patient populations, Neiman Health Policy Institute scholars analyzed commercial claims covering nearly 795,000 men who underwent a PSA test between 2011-2017. They found clear differences, with Black men 24% less likely to receive an MRI after an elevated blood test compared to their white counterparts.

“These results suggest that racial and ethnic disparities exist in the use of subsequent prostate magnetic resonance imaging, highlighting a need to better understand and mitigate physician decision-making biases and other potential sources of the disparities in the identification and management of prostate cancer,” Nino Abashidze, PhD, a postdoctoral researcher at the University of Wyoming, and co-authors wrote Nov. 8.

For the study, researchers tapped the Optum database of insurance claims from members of large commercial and Medicare Advantage plans covering all 50 states. Patients were eligible if they were age 40 or older and had received a single prostate-specific antigen result with no prior PSA or MRI. About 6.5% of the study population (or 51,500 individuals) had PSA levels above 4 nanograms per milliliter, the typical threshold to recommend a prostate biopsy. Of those, 3% had a follow-up MRI exam within the next 180 days.

Black and Asian patients with a 4 or higher on their PSA were about 24% less likely to undergo imaging than white patients. And that number leapt to 35% for Black individuals with results greater than 10 nanograms per milliliter, a marker associated with high rates of biopsy and prostate cancer. Latinos were 23% less likely than whites to undergo MRI at that threshold, the authors reported.

Differences persisted across all age groups except at 75 or older, an age beyond which experts do not recommend continued prostate cancer screening.

“This indicates the important role that clearly defined guidelines can play in addressing racial and ethnic disparities in care,” Danny Hughes, PhD, director of Georgia Tech’s Health Economics & Analytics Lab and senior research fellow with the Neiman Health Policy Institute, said in a statement. “For the age groups for which prostate cancer screening is recommended, clearer guidelines are still needed for the optimal use of prostate MRI.”

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