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Sources of Funding: Emory University Department of Urology Research Scholars Grant_x000D_ Winship Cancer Institute Prostate Cancer Pilot Grant

Introduction

The use and outcomes of MRI-guided prostate biopsy (MRI-Bx) have not been broadly characterized in a nationwide community setting. We evaluated CaP detection rates across Bx types and evaluated subsequent care patterns at a population-level among men covered by private health insurance._x000D_

Methods

Using MarketScan Commercial Claims data (2009-2013), we identified men who underwent Bx without prior CaP diagnosis/treatment. We assigned approach (MRI-Bx vs TRUS-Bx vs transperineal (TP-Bx)) using CPT codes for Bx and pelvic MRI. We assigned MRI-guidance if MRI performed ≤3 months before Bx. Primary outcome was new CaP diagnosis (i.e., ICD-9 185.0). Other outcomes included treatment (yes/no) and treatment type (prostatectomy (RP) vs radiation (RT)) Multivariable logistic regression adjusted for patient and geographic covariates to estimate odds of these outcomes._x000D_

Results

We identified 210,894 men who underwent 1+ Bx (MRI-Bx n=1,378; TRUS-Bx n=208,776, TP-Bx n=740). The mean age of this cohort was 57 years (standard deviation 5 years). Overall, a new CaP diagnosis was most common after TRUS-Bx (36.4%) versus MRI-Bx (28.9%) and TP-Bx (29.3%) (p<0.001). Patients with prior negative Bx were less likely to have a new CaP diagnosis (20.5% vs 37.7% Bx-naive, p<0.001). Patients with prior negative Bx who underwent MRI-Bx were not more likely to be diagnosed with CaP (OR 1.12 vs TRUS-Bx, 95% CI 0.88-1.43) (Figure). Among Bx-naive men, MRI-Bx was associated with a lower odds of CaP detection (OR 0.81 vs TRUS-Bx, 95% CI 0.71-0.93). Patients managed with MRI-Bx and diagnosed with CaP were less likely to receive treatment (OR 0.77, 95% CI 0.62-0.98). There is no association between Bx approach and type of treatment (OR 1.19 RP vs RT, 95% CI 0.90-1.58)._x000D_

Conclusions

During initial adoption, use of MRI-Bx was not associated with significantly increased CaP detection among men with prior negative Bx. Furthermore, patients receiving MRI-Bx were less likely to then have treatment for PCa. These findings merit further investigation, taking tumor and provider factors, including operator experience, into account. _x000D_

Funding

Emory University Department of Urology Research Scholars Grant_x000D_ Winship Cancer Institute Prostate Cancer Pilot Grant