Skip to main content
SpringerLink
Log in

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

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

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

References

  1. Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65(1):5–29

    Article  Google Scholar 

  2. Gordetsky JB et al (2018) Prostate cancer management choices in patients undergoing multiparametric magnetic resonance imaging/ultrasound fusion biopsy compared to systematic biopsy. Urol Oncol 36(5):241 (e7–241 e13)

    Article  PubMed  Google Scholar 

  3. Valerio M et al (2015) Detection of clinically significant prostate cancer using magnetic resonance imaging-ultrasound fusion targeted biopsy: a systematic review. Eur Urol 68(1):8–19

    Article  PubMed  Google Scholar 

  4. Schoots IG et al (2015) Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol 68(3):438–450

    Article  PubMed  Google Scholar 

  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):517–531

    Article  PubMed  Google Scholar 

  6. Schoots IG (2016) Omission of systematic transrectal ultrasound guided biopsy from the MRI targeted approach in men with previous negative prostate biopsy might still be premature. Ann Transl Med 4(10):205

    Article  PubMed  PubMed Central  Google 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):250–266

    Article  PubMed  Google Scholar 

  8. Nettey OS et al (2018) Self-reported Black race predicts significant prostate cancer independent of clinical setting and clinical and socioeconomic risk factors. Urol Oncol 36(11):501 (e1–501 e8)

    Article  PubMed  Google Scholar 

  9. Odedina FT et al (2009) Prostate cancer disparities in Black men of African descent: a comparative literature review of prostate cancer burden among Black men in the United States, Caribbean, United Kingdom, and West Africa. Infect Agent Cancer 4(Suppl 1):S2

    Article  PubMed  PubMed Central  Google Scholar 

  10. Shenoy D et al (2016) Do African-American men need separate prostate cancer screening guidelines? BMC Urol 16(1):19

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sundi D et al (2014) Pathological examination of radical prostatectomy specimens in men with very low risk disease at biopsy reveals distinct zonal distribution of cancer in black American men. J Urol 191(1):60–67

    Article  PubMed  Google Scholar 

  12. Wang M et al (2019) Whole mount histopathological correlation with prostate MRI in Grade I and II prostatectomy patients. Int Urol Nephrol 51(3):425–434

    Article  PubMed  Google Scholar 

  13. Ajayi A et al (2016) Disparities in staging prostate magnetic resonance imaging utilization for nonmetastatic prostate cancer patients undergoing definitive radiation therapy. Adv Radiat Oncol 1(4):325–332

    Article  PubMed  PubMed Central  Google Scholar 

  14. Powell IJ et al (2010) Evidence supports a faster growth rate and/or earlier transformation to clinically significant prostate cancer in black than in white American men, and influences racial progression and mortality disparity. J Urol 183(5):1792–1796

    Article  PubMed  Google Scholar 

  15. Team R (2013) R development core team. RA Lang Environ Stat Comput 55:275–286

    Google Scholar 

  16. Sundi D et al (2013) African American men with very low-risk prostate cancer exhibit adverse oncologic outcomes after radical prostatectomy: should active surveillance still be an option for them? J Clin Oncol 31(24):2991–2997

    Article  PubMed  PubMed Central  Google Scholar 

  17. Mahal BA et al (2018) Prostate cancer-specific mortality across Gleason scores in black vs nonblack men. JAMA 320(23):2479–2481

    Article  PubMed  Google Scholar 

  18. Barrett T, Haider MA (2017) The emerging role of MRI in prostate cancer active surveillance and ongoing challenges. AJR 208(1):131–139

    Article  PubMed  Google Scholar 

  19. Hoffmann R et al (2018) Does the Prostate Imaging-Reporting and Data System (PI-RADS) version 2 improve accuracy in reporting anterior lesions on multiparametric magnetic resonance imaging (mpMRI)? Int Urol Nephrol 50(1):13–19

    Article  CAS  PubMed  Google Scholar 

  20. Polanec S et al (2016) Head-to-head comparison of PI-RADS v2 and PI-RADS v1. Eur J Radiol 85(6):1125–1131

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Division of Urologic Oncology, Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside Building Suite 4954, Mailstop LKS 5046, Cleveland, OH, 44106, USA

    Amr Mahran, Kirtishri Mishra, Laura Bukavina, Christina Buzzy, Vikas Gulani & Lee E. Ponsky

  2. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Amr Mahran, Kirtishri Mishra, Laura Bukavina, Anna Quian, Christina Buzzy, Vikas Gulani & Lee E. Ponsky

  3. Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA

    Fredrick Schumacher

  4. Division of Urology, The Metro Health Medical Center, Cleveland, OH, USA

    Carvell T. Nguyen

  5. Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Vikas Gulani

  6. Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA

    Vikas Gulani

Authors
  1. Amr Mahran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kirtishri Mishra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Bukavina
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fredrick Schumacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anna Quian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christina Buzzy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carvell T. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Vikas Gulani
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lee E. Ponsky
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Corresponding author

Correspondence to Lee E. Ponsky.

Ethics declarations

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mahran, A., Mishra, K., Bukavina, L. et al. Observed racial disparity in the negative predictive value of multi-parametric MRI for the diagnosis for prostate cancer. Int Urol Nephrol 51, 1343–1348 (2019). https://doi.org/10.1007/s11255-019-02158-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-019-02158-6

Keywords

Search

Navigation