Pre-biopsy prostate MRI utilization is up, but researchers see room for improvement

The utilization of pre-biopsy prostate MRI is up significantly among Medicare beneficiaries, according to a new study published in The Journal of Urology. But should that percentage be even higher?

Using national Medicare claims data from October 2010 to September 2015, the authors found that utilization of pre-biopsy MRIs was just 0.1 percent in 2010. That figure has been on the rise ever since, hitting 2.9 percent in 2013 and 10.3 percent in 2015.

The authors pointed out, however, that utilization is still not what it should be.

“Despite the rapid growth in utilization by 2015, the technology remained largely underutilized at the conclusion of our study period in September 2015,” wrote lead author Andrew B. Rosenkrantz, MD, MPA, of the department of radiology at NYU Langone Medical Center in New York, and colleagues. “In that month, approximately 90 percent of prostate biopsies were still performed without an antecedent MRI. Moreover, utilization varied greatly among populations based on various patient characteristics. Such variation suggests disparities in access and the extent to which groups of men are potentially benefitting from prostate MRI in clinical practice.”

The data found, for instance, utilization among white patients was more than 10 percent in 2015. For black patients, it was 5.8 percent.

Also, looking at state-by-state numbers, Wyoming had the highest utilization rate in 2015 with 25 percent. Utilization was more than 23 percent in New York and more than 20 percent in Minnesota. Meanwhile, in 10 different states, the utilization rate was less than 1 percent.

“Such variation is not surprising given the early development of prostate MRI in a limited number of academic medical centers that subsequently served as referral centers for their regional communities (thereby contributing to vast differences in utilization even among neighboring states within a single region of the nation),” the authors wrote.

Rosenkrantz et al. emphasized the important of education in this area. Radiologists may need additional training, including hands-on courses and online training. They also listed some other things that could lead to improved utilization rates.

“Policy initiatives may also be necessary to ensure that pre-biopsy prostate MRI is appropriately covered by payers, whether in the biopsy naïve or repeat biopsy setting,” the authors wrote. “In addition, research investigating the value of prostate MRI in impacting not just cancer detection and diagnostic accuracy, but also downstream patient outcomes, would further foster adoption of prostate MRI in clinical practice.”