Adoption of New Risk Stratification Technologies Within US Hospital Referral Regions and Association With Prostate Cancer Management.

Journal Article (Journal Article)

Importance

The clinical decisions that arise from prostate magnetic resonance imaging (MRI) and genomic testing in patients with prostate cancer are not well understood.

Objective

To evaluate the association between regional uptake of prostate MRI and genomic testing and observation vs treatment for prostate cancer.

Design, setting, and participants

This retrospective cohort study of commercial insurance claims for prostate MRI and genomic testing included 65 530 patients 40 to 89 years of age newly diagnosed with prostate cancer from July 1, 2012, through June 30, 2019.

Exposures

Patient- and regional-level use of prostate MRI and genomic testing.

Main outcomes and measures

Observation vs definitive treatment for prostate cancer. Patient-level analyses examined the association between receipt of testing or residing in a hospital referral region (HRR) that adopted testing and observation. In regional-level analyses, the dependent variable was the change in the proportion of patients observed for prostate cancer at the HRR level between 2 periods: July 1, 2012, to June 30, 2014, and July 1, 2017, to June 20, 2019. The independent study variables included HRR-level changes in the proportion of men undergoing prostate MRI and genomic testing between these periods, and the models were adjusted for contextual factors associated with prostate cancer care and socioeconomic status.

Results

This study identified 65 530 patients, including 27 679 in the early period (mean [SD] age, 58.0 [5.9] years) and 37 851 in the late period (mean [SD] age, 59.0 [5.7] years). Use of prostate MRI increased significantly from 7.2% (95% CI, 6.9%-7.5%) to 16.7% (95% CI, 16.3%-17.1%) from the early to late period. Use of genomic testing increased significantly from 1.3% (95% CI, 1.1%-1.4%) to 12.7% (95% CI, 12.3%-13.0%) from the early to late period. Compared with the lowest, the highest HRR quartiles of prostate MRI and genomic testing uptake were associated with an adjusted 4.1% (SE, 1.1%; P < .001) and 2.5% (SE, 1.1%; P = .03) absolute increase in the proportion of patients receiving observation, respectively.

Conclusions and relevance

In this cohort study, uptake of prostate MRI and genomic testing was associated with increased use of initial observation vs treatment for prostate cancer. Marked geographic variation supports the need for further patient-level research to optimize the dissemination and outcome of testing.

Full Text

Duke Authors

Cited Authors

  • Leapman, MS; Wang, R; Park, HS; Yu, JB; Sprenkle, PC; Dinan, MA; Ma, X; Gross, CP

Published Date

  • October 2021

Published In

Volume / Issue

  • 4 / 10

Start / End Page

  • e2128646 -

PubMed ID

  • 34623406

Pubmed Central ID

  • PMC8501394

Electronic International Standard Serial Number (EISSN)

  • 2574-3805

International Standard Serial Number (ISSN)

  • 2574-3805

Digital Object Identifier (DOI)

  • 10.1001/jamanetworkopen.2021.28646

Language

  • eng