New England Section of the American Urological Association

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Trends and Disparities in mpMRI Utilization for Patients with Newly Elevated PSA Levels from 2019-2023: An Analysis of Medicare Data
Hanna Zurl, MD1, Klara K. Pohl, MD1, Stephan M. Korn, MD2, Nathaniel Hansen, MD3, Zhiyu Qian, MD3, Andrea Piccolini, MD2, Jianyi Zhang, PhD, MS2, Marianne Leitsmann, MD MHBA4, Sascha Ahyai, MD4, Quoc-Dien Trinh, MD MBA5, Alexander P. Cole, MD2.
1Center for Surgery and Public Health, Brigham and Women's Hospital and Medical University of Graz, Boston, MA, USA, 2Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA, 3Brigham and Women's Hospital, Boston, MA, USA, 4Medical University of Graz, Graz, Austria, 5University of Pittsburgh, Pittsburgh, PA, USA.

BACKGROUND: Major guidelines recommend MRI for diagnostic evaluation in patients with newly elevated PSA. This study aimed to investigate trends in the utilization of MRI in patients with newly elevated PSA and assess potential racial and sociodemographic disparities.
METHODS: We utilized Medicare insurance claims data to identify patients with newly elevated PSA levels. We included male patients aged 66 and older with an elevated PSA between 2019 and 2023. We used claims data from 2018 to exclude patients with a preexisting diagnosis of prostate cancer, a preexisting elevated PSA, a previous prostate biopsy, or a preexisting diagnosis of male pelvic cancers. The primary outcome measure was the receipt of an MRI of the prostate within 1 year after elevated PSA. Covariates included race/ethnicity, age group, US region, county type, year of diagnosis, comorbidities, dual eligibility for Medicaid, and Medicare disability status. We performed a clustered logistic regression analysis and calculated yearly counts and percentages to assess time trends in the utilization of MRI.
RESULTS: Our study cohort included 1,009,040 Medicare beneficiaries. 49,128 patients (4.87%) received an MRI within 1 year after elevated PSA. The rate of MRI utilization increased from 3.10% in 2019 to 7.03% in 2023. In multivariable regression analysis, Black patients were significantly more likely to receive an MRI than White patients (OR 1.104, 95%CI 1.031 to 1.182, p=0.0048). Patients living in a rural county (OR 0.668 95%CI 0.600 to 0.743, p<0.0001) were significantly less likely to receive an MRI compared to patients living in a metro county.
CONCLUSIONS: MRI utilization among patients with newly elevated PSA significantly increased from 2019 to 2023. While numerous disparities in prostate cancer screening, diagnosis, and treatment exist, MRI utilization showed reversed racial distribution than previously reported: Black patients were significantly more likely to receive MRI than White patients.
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