Title: Adoption of new Risk stratification technologies within US hospital referral regions and association with prostate cancer management.
Authors: Leapman et al.,
Publication: JAMA network open, 2021
The use of Magnetic Resonance Imaging (MRI) as a non-invasive technique to detect prostate cancer has multiplied in recent years. The use of genomic testing, to provide prognostic estimates from gene-associations, has also shown a rapid diffusion into clinical practice. It has been assumed that the use of MRI and genomic testing improves the precision of management and reduces the overtreatment of prostate cancer. If this is the case, there should be a link between the increased use of MRI and genomic testing and the amount of patients undergoing active surveillance of their prostate cancer.
Leapman and colleagues at the Yale School of Medicine studied this question using insurance claims from 65 530 Americans between 2012 and 2019. The use of prostate MRI and genomic testing increased significantly between the periods 2012-2014 and 2017-2019. Specifically prostate MRI testing went from 7,2% to 16,7%, and genomic testing increased from 1.3% to 12,7%. Active surveillance in the period directly following prostate cancer diagnosis increased as well, from 26,4% to 35,4%. Interestingly, in the 2017-2019 period, 52,2% of patients who received prostate MRI received active surveillance, versus 32,2% of patients who did not receive prostate MRI.
The authors furthermore found a large regional variance in the use of prostate MRI and genomic testing. For MRI this ranged from 0% to 62,7%! Regions with an increase in usage of these prostate MRI and genomic testing also showed an increase in active surveillance of patients. In fact, the regions with the highest compared to lowest use of prostate MRI showed an 4,1% increase of active surveillance versus treatment.
Although this study is unable to indicate causality or directionality of the relation between increases in MRI and genomic testing and active surveillance, it does show that they are related. Thus, the authors suggest that adoption of technologies designed to improve decision-making, such as MRI and genomic testing, may lead to a reduction in overtreatment of prostate cancer.