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High use of mpMRI associated with overtreatment of patients with prostate cancer

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"We found that urology practices increasingly using mpMRI, and tissue-based genomics to a lesser extent, are more likely to treat men who have a high risk of non-cancer mortality. These men have the least to gain from treatment and are likely being overtreated,” says Kassem S. Faraj, MD, MS.

Practices with high use of multiparametric MRI (mpMRI) are more likely to treat patients with prostate cancer who are at an increased risk of non-cancer mortality at 10 years following diagnosis, according to findings published in Urologic Oncology.1

Patients included in the analysis were Medicare beneficiaries who had received a new diagnosis of prostate cancer from 2015 to 2019

Patients included in the analysis were Medicare beneficiaries who had received a new diagnosis of prostate cancer from 2015 to 2019

The study sought to assess the practice-level use of biomarkers (mpMRI and tissue-based genomic testing) and their effect on the treatment patterns of men with prostate cancer.

“Although biomarkers can provide additional information on prostate cancer disease biology, they often ignore patient physiology (ie, underlying health), which is an important indicator of who may benefit from treatment. We found that urology practices increasingly using mpMRI, and tissue-based genomics to a lesser extent, are more likely to treat men who have a high risk of non-cancer mortality. These men have the least to gain from treatment and are likely being overtreated,” said lead author Kassem S. Faraj, MD, MS, in correspondence with Urology Times®. Faraj is a urologic oncology fellow at University of Michigan Medicine in Ann Arbor, Michigan.

For the study, the investigators retrospectively analyzed a 20% random sample of men using national Medicare data. Those included in the analysis were Medicare beneficiaries who had received a new diagnosis of prostate cancer from 2015 to 2019. Non–cancer-specific mortality at 10 years was calculated for each patient. Practice-level use of either mpMRI or genomic testing were characterized as never, below the median, or above the median. The primary outcome was treatment within 1 year of diagnosis.

In total, 2661 practices treating men with prostate cancer in 2015 were identified for analysis. Among those, 1764 (65%) of the urology practices utilized mpMRI and 897 (33%) utilized genomic testing during the year analyzed.

Data showed that practices that used mpMRI above the median (56% of practices) were more likely to treat men who had a greater than 75% risk of non-prostate cancer-specific mortality compared with practices (47%) that did not use mpMRI at all (P = .003). There was no significant difference in treatment among patients with a less than 25% risk of non-cancer mortality based on practices (72%) that used mpMRI compared with those (69%) that did not (P = .07).

The investigators also found that practices that used genomic testing below the median (55.9% of practices) were more likely to treat men who had a high risk of non-prostate cancer-specific mortality compared with practices (50.1%) that did not use genomic testing at all (P = .03). There was no significant difference in treatment among patients with a less than 25% risk of non-cancer mortality based on practices (71%) that used genomic testing compared with those (70%) that did not (P = .65).

Faraj concluded, “Professional guidelines could consider stratifying recommendations on biomarker use according to patient physiology to reduce the risk of overtreatment in men with poor underlying health who otherwise would be managed conservatively.”

Reference

1. Faraj KS, Kaufman SR, Herrel LA, Oerline MK, Maganty A, Shahinian VB, Hollenbeck BK. Association between urology practice use of multiparametric MRI and genomic testing and treatment of men with newly diagnosed prostate cancer. Urol Oncol. Published online August 12, 2023. Accessed August 23, 2023. doi:10.1016/j.urolonc.2023.08.002

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