Racial and Ethnic Disparities Identified in Those With a High PSA Undergoing MRI Imaging for Prostate Cancer

Investigators noted that racial and ethnic factors influenced which patients with elevated prostate-specific antigen (PSA) levels received subsequent MRI, highlighting a need to improve decision making biases and identify other reasons for disparities in prostate cancer, according to a study published in JAMA Open Network.¹

Black patients who had a PSA of more than 4 ng/mL were 24.1% less likely to receive a prostate MRI scan compared with White patients (odds ratio [OR], 0.78; 95% CI, 0.65-0.89). Similarly Black patients with a PSA of more than 10 ng/mL were 35.0% less likely to undergo further MRI scans vs White patients (OR, 0.65; 95% CI, 0.50-0.85). Moreover, Asian patients who had a PSA higher than 4 ng/mL (OR, 0.76; 95% CI, 0.58-0.99) and Hispanic patients who had a PSA higher than 10 ng/mL (OR, 0.77; 95% CI, 0.59-0.99) were also less likely to undergo further MRI than White patients.

“We can’t say definitively if the reason Black, Hispanic, and Asian men did not receive this particular test is that physicians did not refer them for it, or if the patients opted themselves out of further testing,” Danny Hughes, PhD, a professor of the school of economics at Ivan Allen College of Liberal Arts, Georgia Tech, said in a press release.² “Regardless, these disparities do highlight the need to understand what is happening and how to ensure patients of all races and ethnicities receive the best possible care.”

The cohort study utilized deidentified data pulled from an administrative database. Investigators identified a total of 1,563,534 tests from 2011 to 2017 that met the criteria for the study, results of which were available in 50.8% of unique participants. Patients had a mean age of 59.8 years. In terms of race, 9.6% of patients were Black, 13.6% were Hispanic, 3.9% were Asian, 57.3% were White, and 15.6% were of another race. Additionally, 6.5% of patients had a PSA of more than 4 ng/mL and 3.0% received a subsequent MRI following PSA testing.

Investigators identified an upward trend in terms of the number of patients with a high PSA undergoing MRI imaging. Additionally, the mean number of days between PSA testing and MRI imaging decreased from 80 days in 2011 to 60 days in 2017.

Further findings from the study indicated that Black patients who were aged 65 to 74 years who had a PSA of more than 4 ng/mL and 10 ng/mL were 23.6% (OR0.76; 95% CI, 0.64-0.91) and 43.9% (OR, 0.56; 95% CI, 0.59-0.99) less like to undergo MRI imaging, respectively. Moreover, Black patients between the ages of 40 to 54 years with a PSA higher than 4 ng/mL were 39.8% less likely to undergo MRI imaging vs White patients in the same age group (OR, 0.60; 95% CI, 0.38-0.95). Notably, estimates in terms of other age groups and PSA results did not appear to be statistically significant, investigators reported.

“In addition to a lack of clear guidelines on the use of prostate MRI following a PSA test, both unconscious and conscious biases may play a role in this health care inequity. For example, prior research has shown that physicians are less likely to discuss treatment options and potential side effects with Black vs White patients. Further research is needed to assess the role of these decision-making biases among physicians relative to other potential sources in the health care system for the observed racial and ethnic disparities in the use of prostate MRI, as well as examining whether these disparities extend to the use of prostate biopsy,” investigators concluded.

References

1. Abashidze N, Stecher C, Rosenkrantz AB, et al. Racial and ethnic disparities in the use of prostate magnetic resonance imaging following an elevated prostate-specific antigen test. JAMA Netw Open. 2021;4(11):e2132388. doi:10.1001/jamanetworkopen.2021.32388
2. New study reveals racial, ethnic disparities in use of increasingly popular prostate cancer test. News release. Georgia Tech. November 8, 2021. Accessed November 11, 2021. https://b.gatech.edu/30dQaUB