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International Urology and Nephrology

, Volume 51, Issue 8, pp 1343–1348 | Cite as

Observed racial disparity in the negative predictive value of multi-parametric MRI for the diagnosis for prostate cancer

  • Amr Mahran
  • Kirtishri Mishra
  • Laura Bukavina
  • Fredrick Schumacher
  • Anna Quian
  • Christina Buzzy
  • Carvell T. Nguyen
  • Vikas Gulani
  • Lee E. PonskyEmail author
Urology - Original Paper

Abstract

Objective

To evaluate the trend that despite recent advances in the screening, diagnosis, and management of prostate cancer (PCa), African-Americans (AAs) continue to have poorer outcomes compared to their Caucasian (CAU) counterparts. The reason for this may be rooted in biological differences in the cancer between the two groups; however, there may be some inherent disparities within the efficacy of the screening modalities. In this study, we aim to evaluate the negative predictive value (NPV) of multi-parametric MRI (mpMRI) between AA compared to CAUs.

Methods

All mpMRI between January 2014 and June 2017 were evaluated. The MRIs were read by dedicated genitourinary radiologists. Subsequently, the readings were correlated to final pathology after the patients underwent radical prostatectomy. The NPV and negative likelihood ratios (−LR) of mpMRI were evaluated in AAs versus CAUs based on four cutoffs (≥ Grade I, ≥ Grade II, ≥ Grade III and ≥ Grade IV).

Results

The mpMRI was almost equally as effective between AAs and CAUs in excluding Grade III (NPV = 89 and 94, respectively), and Grade IV or above (NPV = 96 and 98, respectively) PCa; however, the NPV of mpMRI was significantly lower for Grade I (NPV = 32 and 52, respectively) and Grade II (NPV = 50 and 79, respectively) PCa.

Conclusion

Despite advances in the screening for PCa, there are disparities noted in the efficacy of screening tools between AAs and CAUs. For this reason, patients should be risk stratified and their screening results should be evaluated with consideration given to their baseline risk.

Keywords

Prostate cancer Multi-parametric MRI Racial disparity Negative predictive value 

Abbreviations

AA

African-American

CAU

Caucasian

mpMRI

Multi-parametric magnetic resonance imaging

NPV

Negative predictive value

PCa

Prostate cancer

PI-RADS

Prostate Imaging Reporting and Data System

PSA

Prostate-specific antigen

csPCa

Clinically significant prostate cancer

EAU

European Association of Urology

PSAD

PSA density

Notes

Author contributions

Conception and design: AMKM, LP. Administrative support: CN, VG, LP. Provision of study material or patients: AM, CB. Collection and assembly of data: KM, AQ, LB, AM. Data analysis and interpretation: AM, LB, KM. Manuscript writing: all authors. Final approval of manuscript: all authors.

Funding

None.

Compliance with ethical standards

Conflict of interest

Amr Mahran, MD, declares that he has no conflict of interest. Kirtishri Mishra, MD, declares that he has no conflict of interest. Laura Bukavina declares that she has no conflict of interest. Fredrick Schumacher, PhD, declares that he has no conflict of interest. Anna Quian, BS, declares that she has no conflict of interest. Christina Buzzy, PhD, declares that she has no conflict of interest. Carvell T. Nguyen, MD, PhD, declares that he has no conflict of interest. Vikas Gulani, MD, PhD, declares that he has no conflict of interest. Lee E. Ponsky, MD, declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Due to the retrospective nature of the study, informed consent was waived per IRB review protocol.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Division of Urologic Oncology, Urology InstituteUniversity Hospitals Cleveland Medical CenterClevelandUSA
  2. 2.Case Western Reserve University School of MedicineClevelandUSA
  3. 3.Department of Population and Quantitative Health SciencesCase Western Reserve UniversityClevelandUSA
  4. 4.Division of UrologyThe Metro Health Medical CenterClevelandUSA
  5. 5.Department of RadiologyUniversity Hospitals Cleveland Medical CenterClevelandUSA
  6. 6.Department of Biomedical EngineeringCase Western Reserve UniversityClevelandUSA

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