Observed racial disparity in the negative predictive value of multi-parametric MRI for the diagnosis for prostate cancer
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.
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).
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.
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.
KeywordsProstate cancer Multi-parametric MRI Racial disparity Negative predictive value
Multi-parametric magnetic resonance imaging
Negative predictive value
Prostate Imaging Reporting and Data System
Clinically significant prostate cancer
European Association of Urology
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.
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.
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.
Due to the retrospective nature of the study, informed consent was waived per IRB review protocol.
- 5.Wegelin O et al (2017) Comparing three different techniques for magnetic resonance imaging-targeted prostate biopsies: a systematic review of in-bore versus magnetic resonance imaging-transrectal ultrasound fusion versus cognitive registration. Is there a preferred technique? Eur Urol 71(4):517–531CrossRefGoogle Scholar
- 7.Moldovan PC et al (2017) What is the negative predictive value of multiparametric magnetic resonance imaging in excluding prostate cancer at biopsy? A systematic review and meta-analysis from the European association of urology prostate cancer guidelines panel. Eur Urol 72(2):250–266CrossRefGoogle Scholar
- 15.Team R (2013) R development core team. RA Lang Environ Stat Comput 55:275–286Google Scholar