An Examination of Racial and Ethnic Disparities in the Use of Prostate Biopsy and Magnetic Resonance Imaging in Prostate Cancer Screening

Introduction:We assessed racial and ethnic disparities in the use of prostate biopsy or MRI following an elevated PSA result.Methods:We retrospectively evaluated insurance claims from Optum's de-identified Clinformatics Data Mart database from January 1, 2011 to December 31, 2017. This was a large commercially insured cohort from across the United States. We included all male enrollees over 40 years old receiving an elevated PSA result with no prior prostate biopsy or MRI and no confirmed urinary tract infection within 6 weeks of PSA test.Results:A total of 765,409 participants met inclusion criteria with 43,711 (5.71%) receiving a PSA result above 4 ng/mL. Of these, 7,399 received either a prostate biopsy or MRI within 180 days. Men between ages 40-54 (29.48%) were most likely to receive prostate biopsy or MRI after an elevated PSA, followed by those between 55-64 (24.91%), 65-74 (18.56%), 75-84 (6.33%), and above 85 (3.62%). Compared to White patients, Black patients were more likely to receive either a prostate biopsy or MRI (OR: 1.16, 95% CI: 1.01, 1.32) following an elevated PSA level, while Asian (OR: 0.72, 95% CI: 0.54, 0.96) and Hispanic (OR: 0.83, 95% CI: 0.70, 0/97) patients were less likely.Conclusions:Physicians appear to be following the reported statistical incidence of prostate cancer by race and ethnicity when using prostate biopsy or MRI for patients with elevated PSA levels. These results demonstrate the importance of publishing statistical data on disease incidence by race and ethnicity for informing physicians' decision-making.