Despite potential benefit, use of preoperative MRI low before radical prostatectomy

A database review of over 19,000 men with prostate cancer who received a radical prostatectomy between 2003 and 2016 showed a link between preoperative magnetic resonance imaging (MRI) and reduced odds of positive surgical margins and the need for blood transfusions at 30 and 90 days. However, only 10% of the patients had a preoperative MRI scan, according to a study published in the Journal of Urology.1

Using 2018 statistics from the Surveillance, Epidemiology, and End Results (SEER) database, the study authors assessed data from 19,369 male Medicare beneficiaries (66 years of age and older) who were diagnosed with non-metastatic prostate cancer and subsequently underwent a radical prostatectomy within a year of diagnosis.

The study authors found that 13.5% of patients who did not have a pre-op MRI had positive surgical margins in comparison to 10.3% in the pre-op MRI cohort. According to the study, 2.5% of patients in the no MRI group needed blood transfusions within a month after surgery in comparison to 1.7% of patients in the pre-op MRI group. At 90 days out, 2.7% of those that did not have pre-op MRIs required blood transfusions in comparison to 1.8% in the pre-op MRI cohort.

While only 10% of the entire study population had a pre-op MRI scan, researchers did note increased usage over the years, going from 2.9% in 2004 to 28.2% of patients in 2015.

“Although (preoperative MRI was) only performed in about a quarter of men receiving prostatectomy, (it) is associated with lower odds of positive surgical margins across a nationally representative sample,” noted Alexander P. Cole, MD, an Assistant Professor of Surgery at Harvard Medical School and Associate Surgeon in the Division of Urological Surgery at the Center for Surgery and Public Health at Brigham and Women’s Hospital, and colleagues.

The researchers also noticed racial disparities in their research.

The study population largely consisted of White men (84.7%) followed by Black men (7.3%), other races (6.5%) and Hispanic men (1.5%), according to the study. The study authors found that 10.2% of White men had a pre-op MRI scan in comparison to 6.1% of Black men and 4.1% of Hispanic men.

Cole and colleagues also pointed out that men who were less likely to live outside of their hospital referral region were more likely to have had pre-op MRI.

Noting the study’s focus on MRI use among fee-for-service Medicare beneficiaries 66 years of age and older, the study authors acknowledged the possibility of bias due to varying use of Medicare Advantage between and within states, and whether that might possibly influence a surgeon’s decision to obtain pre-op MRI for fee-for-service beneficiaries versus Medicare Advantage beneficiaries.

In regard to other study limitations, the authors said the use of the 2018 SEER data for the study precluded any impact from new developments in treatment that may have occurred after 2016. They also noted a lack of information on factors ranging from body habitus to surgeon caseload and length of stay.

Reference

1. Cole AP, Chen X, Langbein BJ, et al. Geographic Variability, Time Trends and Association of Preoperative Magnetic Resonance Imaging with Surgical Outcomes for Elderly United States Men with Prostate Cancer: A Surveillance, Epidemiology, and End Results-Medicare Analysis. J Urol. 2022 ;208(3):609-617. doi: 10.1097/JU.0000000000002736