Abstract
The clinical decisions that arise from prostate magnetic resonance imaging (MRI) and genomic testing in patients with prostate cancer are not well understood. To evaluate the association between regional uptake of prostate MRI and genomic testing and observation vs treatment for prostate cancer. This retrospective cohort study of commercial insurance claims for prostate MRI and genomic testing included 65 530 patients 40 to 89 years of age newly diagnosed with prostate cancer from July 1, 2012, through June 30, 2019. Patient- and regional-level use of prostate MRI and genomic testing. Observation vs definitive treatment for prostate cancer. Patient-level analyses examined the association between receipt of testing or residing in a hospital referral region (HRR) that adopted testing and observation. In regional-level analyses, the dependent variable was the change in the proportion of patients observed for prostate cancer at the HRR level between 2 periods: July 1, 2012, to June 30, 2014, and July 1, 2017, to June 20, 2019. The independent study variables included HRR-level changes in the proportion of men undergoing prostate MRI and genomic testing between these periods, and the models were adjusted for contextual factors associated with prostate cancer care and socioeconomic status. This study identified 65 530 patients, including 27 679 in the early period (mean [SD] age, 58.0 [5.9] years) and 37 851 in the late period (mean [SD] age, 59.0 [5.7] years). Use of prostate MRI increased significantly from 7.2% (95% CI, 6.9%-7.5%) to 16.7% (95% CI, 16.3%-17.1%) from the early to late period. Use of genomic testing increased significantly from 1.3% (95% CI, 1.1%-1.4%) to 12.7% (95% CI, 12.3%-13.0%) from the early to late period. Compared with the lowest, the highest HRR quartiles of prostate MRI and genomic testing uptake were associated with an adjusted 4.1% (SE, 1.1%; P < .001) and 2.5% (SE, 1.1%; P = .03) absolute increase in the proportion of patients receiving observation, respectively. In this cohort study, uptake of prostate MRI and genomic testing was associated with increased use of initial observation vs treatment for prostate cancer. Marked geographic variation supports the need for further patient-level research to optimize the dissemination and outcome of testing.
Highlights
There have been dramatic recent increases in the acceptance of active surveillance for prostate cancer, a period of close monitoring followed by timely treatment if needed.[1]
The highest hospital referral region (HRR) quartiles of prostate magnetic resonance imaging (MRI) and genomic testing uptake were associated with an adjusted 4.1% (SE, 1.1%; P < .001) and 2.5% (SE, 1.1%; P = .03) absolute increase in the proportion of patients receiving observation, respectively. In this cohort study, uptake of prostate MRI and genomic testing was associated with increased use of initial observation vs treatment for prostate cancer
In a secondary analysis conducted at the patient level, we examined the association between prostate MRI and genomic testing and observation for prostate cancer using descriptive statistics
Summary
There have been dramatic recent increases in the acceptance of active surveillance for prostate cancer, a period of close monitoring followed by timely treatment if needed.[1]. Retrospective and registry-based studies suggest that genomic tests augment decision-making, steering more patients toward observation, but are limited by their study design and possible external bias from industry sponsorship.[11,12,13] Determining the effectiveness of these technologies is critical given their expense and potential for decisional conflict associated with their results.[14] The availability of these technologies coincides with transformational shifts in the acceptance of observation management strategies, such as active surveillance.[10] the extent to which prostate MRI and genomic testing have directly facilitated the adoption of observation rather than immediate treatment may be difficult to appreciate in analyses conducted at the individual patient level
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