Geographic Variability, Time Trends and Association of Preoperative MRI with Surgical Outcomes for Elderly US Men with Prostate Cancer: A SEER-Medicare Analysis.

To assess patterns of adoption and population-level outcomes of prostate MRI and association with surgical outcomes across a sample of US elderly.

This population-based retrospective study used Surveillance Epidemiology and End Results (SEER)-Medicare linked data from 2003-2016 to identify men receiving prostatectomy for prostate cancer. We characterized the proportion of men receiving pre-operative MRI in each year and in each hospital referral region (HRR). A two-stage instrumental variable analysis (IVA) was performed to assess the association of pre-operative MRI with margin status, surgical complications, and further cancer-directed therapies.

A total of 19,369 men received prostatectomy in 72 HRRs, the mean age was 70.2 (SD 3.2). The proportion of men receiving a pre-operative MRI increased from 2.9% to 28.2% over the study period and ranged from 0.0% to 28.8% in the different HRRs. In our IVA, preoperative MRI was associated with lower odds of positive surgical margin (OR 0.84, 95% CI 0.72-0.97, p=0.01) lower odds of blood transfusions at 30 and 90 days (OR 0.56 95% CI 0.38-0.83 p=0.003 and OR 0.58 95% CI 0.41-0.84, p=0.004) but higher odds of further treatments (OR 1.49 95% CI 1.32-1.70, p <0.001).

Given that a minority of men receive pre-surgical MRIs with marked geographic variability, the association of MRI with lower odds of positive surgical margin suggests that efforts to support the dissemination of prostate MRI may improve surgical outcomes-but may come with a tendency for more resource-intensive cancer care overall.

The Journal of urology. 2022 May 10 [Epub ahead of print]

Alexander P Cole, Xi Chen, Bjoern J Langbein, Francesco Giganti, Veeru Kasivisvanathan, Mark Emberton, Caroline Moore, Stuart R Lipsitz, Nancy L Keating, Quoc-Dien Trinh

Division of Urological Surgery, and Center for Surgery and Public Health Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., UCL Division of Surgery & Interventional Science, University College London, London, UK., Center for Surgery and Public Health and Division of General Internal Medicine Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Department of Health Care Policy Harvard Medical School, and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.

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