Did you get an MRI scan as part of your clinical work-up for prostate cancer risk?

A report in the journal Urology (the so-called “Gold Journal”) from a team of researchers at Yale School of Medicine has shown that having a prostate MRI as part of the work-up for a patient initially diagnosed with low-risk prostate cancer roughly doubled the chance that such a patient was initially managed on “observation”.

It is important, in understanding these data, to appreciate that “observation” could have included anything from intense active surveillance to the most minimal forms of watchful waiting (the latter in older men with comorbid conditions and a limited life expectancy). Also, all men in the SEER-Medicare database have to have been 65 or more years of age.

Leapman et al. looked at data available in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database for information about men initially diagnosed with low-risk prostate cancer between 2010 and 2013.

They found the following:

  • The database included 8,144 men diagnosed with low-risk prostate cancer within that time period.
  • 495/8,144 patients (6.1 percent) were given and MRI as one component of their work-up.
  • Use of MRI scans increased over the study period
    • From 3.4 percent in 2010
    • To 10.5 percent in 2013
  • 3,060/8,144 patients (37.6 percent) were initially managed on “observation”
  • MRI scans were performed on
    • 265/3,060 patients (8.7 percent) who were initially managed on “observation”
    • 230/5,084 patients (4.5 percent) who received some form of immediate treatment
  • Being a low-risk patient and being given an MRI (as compared to not being given an MRI) signifciantly increased the probability that low-risk patiensts were initially managed on observation (odds ratio [OR] = 1.90).
  • Socioeconomic status also appears to have been a significant factor in whether patients were offered or given an MRI scan.

The “New” Prostate Cancer InfoLink is not surprised by these data … but we would love to know how these data have changed from the 2010-2013 time frame to the 2015-2018 time frame as the accumulated data on the benefits of MRI scans in the initial work-up of patients with very low-, low- and intermediate-risk prostate cancer have gradually increased.

We suspect that:

  • A far higher percentage of low-risk patients were receiving MRI scans in the 2015-2018 time period
  • A far higher percentage pf low-risk patients were being initially managed on some form of “observation” in that same time period
  • Socioeconomic status remained a key factor in the likelihood that patients were offered or accepted MRI scans in the 2015-2018 time period

2 Responses

  1. I see it the same way on all points.

    It makes sense that a favorable MRI result decreases uncertainty and significantly increases confidence that observation is suitable.

  2. Yes I did, in Uppsala where I was treated, so far with complete success since late January 2009. The diagnosis was in Amsterdam, with a biopsy: high risk. I applied immediately for an MRI there, in November 2008. It was summarily refused with the words “the planning.” This happened again, a week or two in December. And again, after I returned from my secret second opinion there and was invited there for a world class treatment that was also refused me in Amsterdam — by a medically dodgey guideline and an age limit. I told the MRI people to …. off. While I was in the plane to Sweden, the MRI staff called my partner. In a happy loud voice they told her that I could come the following day or week (around 12 January 09). She burst out laughing and told them where I was and what I was up to. The MRI and some other staging gizmo put me at T2c.

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