Study Finds Key Benefits and Low Use of Pre-Op MRI for Patients Having Surgery for Prostate Cancer

Despite increased use of preoperative magnetic resonance imaging (MRI) in recent years for patients undergoing surgery for prostate cancer, a study found that over 70 percent of a large Medicare population with prostate cancer did not have a preoperative MRI scan as of 2015.

In a study of over 19,300 men who underwent a prostatectomy for prostate cancer between 2003 and 2016, researchers noted that preoperative magnetic resonance imaging (MRI) was associated with lower odds of positive surgical margins as well as lower odds for blood transfusions at 30 and 90 days. However, only 10 percent of the patients had a preoperative MRI scan, according to the recently published study in the Journal of Urology.

Using 2018 statistics from the Surveillance, Epidemiology, and End Results (SEER) database, the study authors assessed data from 19,369 male Medicare beneficiaries (66 years of age and older) who were diagnosed with non-metastatic prostate cancer and subsequently underwent a radical prostatectomy within a year of diagnosis.

The study authors found that 13.5 percent of patients who did not have a pre-op MRI had positive surgical margins in comparison to 10.3 percent in the pre-op MRI cohort. According to the study, 2.5 percent of patients in the no MRI group needed blood transfusions within a month after surgery in comparison to 1.7 percent of patients in the pre-op MRI group. At 90 days out, 2.7 percent of those that did not have pre-op MRIs required blood transfusions in comparison to 1.8 percent in the pre-op MRI cohort.

While only 10 percent of the entire study population had a pre-op MRI scan, researchers did note increased usage over the years, going from 2.9 percent in 2004 to 28.2 percent of patients in 2015.

“Although (preoperative MRI was) only performed in about a quarter of men receiving prostatectomy, (it) is associated with lower odds of positive surgical margins across a nationally representative sample,” noted Alexander P. Cole, MD, an Assistant Professor of Surgery at Harvard Medical School and Associate Surgeon in the Division of Urological Surgery at the Center for Surgery and Public Health at Brigham and Women’s Hospital, and colleagues.

The researchers also noticed racial disparities in their research.

The study population largely consisted of White men (84.7 percent) followed by Black men (7.3 percent), other races (6.5 percent) and Hispanic men (1.5 percent), according to the study. The study authors found that 10.2 percent of White men had a pre-op MRI scan in comparison to 6.1 percent of Black men and 4.1 percent of Hispanic men.

Cole and colleagues also pointed out that men who were less likely to live outside of their hospital referral region were more likely to have had pre-op MRI.

Noting the study’s focus on MRI use among fee-for-service Medicare beneficiaries 66 years of age and older, the study authors acknowledged the possibility of bias due to varying use of Medicare Advantage between and within states, and whether that might possibly influence a surgeon’s decision to obtain pre-op MRI for fee-for-service beneficiaries versus Medicare Advantage beneficiaries.

In regard to other study limitations, the authors said the use of the 2018 SEER data for the study precluded any impact from new developments in treatment that may have occurred after 2016. They also noted a lack of information on factors ranging from body habitus to surgeon caseload and length of stay.