PD50-07 TIME TRENDS AND GEOGRAPHIC VARIABILITY IN PREOPERATIVE MRI FOR PROSTATE CANCER AND ITS ASSOCIATION WITH SURGICAL MARGIN STATUS IN THE UNITED STATES

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening V (PD50)1 Sep 2021PD50-07 TIME TRENDS AND GEOGRAPHIC VARIABILITY IN PREOPERATIVE MRI FOR PROSTATE CANCER AND ITS ASSOCIATION WITH SURGICAL MARGIN STATUS IN THE UNITED STATES Alexander Putnam Cole, Xi Chen, Francesco Giganti, Veeru Kasivisvanathan, Logan Briggs, Khalid Alkhatib, Mark Emberton, Caroline Moore, Stuart R Lipsitz, Nancy L Keating, and Quoc-Dien Trinh Alexander Putnam ColeAlexander Putnam Cole More articles by this author , Xi ChenXi Chen More articles by this author , Francesco GigantiFrancesco Giganti More articles by this author , Veeru KasivisvanathanVeeru Kasivisvanathan More articles by this author , Logan BriggsLogan Briggs More articles by this author , Khalid AlkhatibKhalid Alkhatib More articles by this author , Mark EmbertonMark Emberton More articles by this author , Caroline MooreCaroline Moore More articles by this author , Stuart R LipsitzStuart R Lipsitz More articles by this author , Nancy L KeatingNancy L Keating More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002072.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of MRI for diagnosis and staging of prostate cancer has seen large increases in recent decades. While MRI benefits diagnosis, staging, and risk stratification, evidence about its impact on surgical outcomes is limited. We assessed temporal trends and geographic variability in the use of MRI before prostatectomy among a large, nationally representative cohort of older men and assessed the impact of preoperative MRI on surgical outcomes. METHODS: Using the SEER/Medicare linked dataset, we identified men aged ≥66 years with localized prostate cancer treated with radical prostatectomy from 2004-2015 in the United States. The main independent variable was receipt of an MRI within 90 days prior to surgery. Within each hospital referral region (HRR), we calculated the proportion of men receiving preoperative MRI. To decrease the effect of unmeasured confounders, a clustered two-stage instrumental variable analysis was performed using HRR-level intensity of MRI use as the instrument and surgical margin as the main outcome variable. Secondary outcomes included complications at 30 and 90 days after surgery and receipt of additional prostate-cancer directed therapies at 6 months. RESULTS: A total of 22,814 men were identified who received prostatectomy from 2004-2015 in 72 HRRs. The proportion of men receiving a pre-operative MRI increased from 2.8% in 2004 to 19.3% in 2015 and ranged from 0.0% to 67.4% across HRRs. Our instrumental variables analysis revealed a statistically significant association between HRR level intensity of preoperative MRI and lower odds of positive surgical margin (OR 0.776, 95% CI 0.623 to 0.966) but higher odds of additional prostate cancer directed treatments within six months (OR 1.262, 95% CI 1.101-1.446). CONCLUSIONS: Receipt of preoperative MRI has increased during the study period with considerable geographic variability. Receipt of preoperative MRI was associated with lower odds of positive surgical margin, but greater odds of short-term additional cancer directed therapies. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e854-e854 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Putnam Cole More articles by this author Xi Chen More articles by this author Francesco Giganti More articles by this author Veeru Kasivisvanathan More articles by this author Logan Briggs More articles by this author Khalid Alkhatib More articles by this author Mark Emberton More articles by this author Caroline Moore More articles by this author Stuart R Lipsitz More articles by this author Nancy L Keating More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement Loading ...