Presentation Authors: Andrew Higgins*, Jiangtao Gou, Laura McGarry, Bret Marlowe, Claudette Fonshell, Edouard Trabulsi, Mark Mann, David Chen, Philadelphia, PA, John Danella, Danville, PA, Thomas Guzzo, Philadelphia, PA, Thomas Lanchoney, Bryn Mawr, PA, Jay Raman, Hershey, PA, Adam Reese, Philadelphia, PA, Jeffrey Tomaszewski, Camden, NJ, Marc Smaldone, Robert Uzzo, Serge Ginzburg, Philadelphia, PA
Introduction: CT and MRI are acceptable imaging modalities in diagnosis and staging of prostate cancer (CaP). We examine axial imaging utilization patterns across a large regional collaborative, with a focus on racial disparity in MRI utilization.
Methods: PURC is a prospective regional collaborative comprised of nine large academic and private urology practices in Southeastern PA and NJ, launched in 2015. Demographic and clinicopathologic data for men with clinically localized CaP were abstracted and axial imaging modality (CT vs. MRI) was evaluated. Fisher&[prime]s exact t-test, ANOVA, Wilcoxon rank sum test and logistic regression models were utilized for univariable and multivariable analyses, respectively.
Results: Between January 2015 and May 2018, 6109 eligible patients were enrolled in PURC. Patients with clinically localized CaP that underwent axial imaging and had sufficient information were included, resulting in 1376 men in the cohort of interest. Demographic and clinicopathologic characteristic of the cohort are described in Table. Overall, MRI was found to be a more common imaging modality than CT (68.6% vs 31.4%). Caucasian men were more likely to undergo MRI than African-American (AA) men (72.1% vs 57.0%, p < 0.001) on univariable analysis. Caucasian race (OR 1.87, 95% CI 1.30-2.69, p < 0.001) was a strong independent predictor of MRI utilization on multivariable analysis, along with younger age (p=0.008), lower PSA value (p=0.009), lower Gleason score (p < 0.001) and treatment at a practice with higher patient throughput (p < 0.001). Significant variation was observed across individual practice sites (Figure).
Conclusions: Significant racial disparity in axial imaging utilization exists across PURC, with lower rates of MRI utilization in AA men. Variation in the utilization and in the degree of this disparity was observed across individual practices. More granular data is needed to better understand underlying causes of such disparity.
Source of Funding: Data was provided with permission from the Pennsylvania Urologic Regional Collaborative (PURC), funded by participating urology practices and the Partnership for Patient Care, a quality improvement initiative supported by the Health Care Improvement Found