Racial disparity in the utilization of multiparametric MRI-ultrasound fusion biopsy for the detection of prostate cancer

• Published in: Prostate cancer and prostatic diseases Vol. 23; no. 4; pp. 567 - 572
• Main Authors: Hoge, Connor, Verma, Sadhna, Lama, Daniel J, Bergelson, Ilana, Haj-Hamed, Monzer, Maynor, Sean, Gaitonde, Krishnanath, Sidana, Abhinav
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.12.2020
• Subjects: African Americans; Aged; Antigens; Biopsy; Black or African American; Black People - statistics & numerical data; Cancer; Diagnosis; Genetics; Healthcare Disparities - statistics & numerical data; Humans; Image-Guided Biopsy - methods; Image-Guided Biopsy - statistics & numerical data; Kallikreins - blood; Magnetic resonance imaging; Male; Middle Aged; Multiparametric Magnetic Resonance Imaging - methods; Multiparametric Magnetic Resonance Imaging - statistics & numerical data; Neoplasm Grading; Prostate cancer; Prostate-specific antigen; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - ethnology; Prostatic Neoplasms - pathology; Race; Race factors; Racism - statistics & numerical data; Rectum; Regression analysis; Retrospective Studies; Ultrasonic imaging; Ultrasonography - methods; Ultrasonography - statistics & numerical data; Ultrasound; United States; Utilization; White people; White People - statistics & numerical data; United States
• ISSN: 1365-7852; 1476-5608; 1476-5608
• DOI: 10.1038/s41391-020-0223-5

Black men have significantly higher incidence and are up to three times more likely to die of prostate cancer (PCa) than White men. Multiparametric magnetic resonance imaging-ultrasound fusion biopsy (FBx) has emerged as a promising modality for the detection of PCa. The goal of our study is to identify differences in utilization of FBx between Black and White men presenting with suspicion of PCa. We performed a retrospective review of Black and White men who presented with suspicion of PCa and required biopsy from January 2014 to December 2018. Multivariate logistic regression analysis was done to study the influence of race on the utilization of FBx. Six hundred nineteen (Black: 182, White: 437) men were included in the study. Forty-one out of 182 (22.5%) Black men underwent FBx compared with 225/437 (51.5%) of White men (P < 0.001). After adjusting for age, race, prostate-specific antigen level, digital rectal exam, family history of PCa and health insurance provider, Black race was found to be a significant negative predictor of obtaining FBx (OR:0.32, 95% CI: 0.21-0.51, P < 0.001). Black race stayed an independent negative predictor (OR: 0.36, 95% CI: 0.20-0.64, P < 0.001) in the cohort of patients who were biopsy naïve; however, although reduced, there was no significant difference in the cohort with a prior negative biopsy (OR: 0.51, 95% CI: 0.19-1.36, P = 0.179). Although FBx is a superior modality for early detection of PCa, we found that Black men were less likely to undergo FBx when presenting with PCa suspicion. Further investigation is needed to evaluate if this difference is patient preference or if there are underlying socioeconomic, cultural or provider biases influencing this disparity.