Men with low-risk prostate cancer (PCa) who undergo prostate magnetic resonance imaging (MRI) scans as part of their diagnostic work-up may be more likely to be managed with observation than to receive definitive treatment, according to a new study.

In a study of 8144 men diagnosed with low-risk PCa during the period from 2010 to 2013, prostate MRI was performed in 265 patients (8.7%) who received observation compared with 230 (4.5%) who underwent treatment. After propensity score matching, receipt of MRI was associated with significant 1.9-fold greater odds of being managed with observation than undergoing definitive treatment, Michael S. Leapman, MD, of the Yale School of Medicine in New Haven, Connecticut, and colleagues reported online ahead of print in Urology.

“The association identified in our study between MRI use and initial observation may serve as an informative basis for examining strategies to improve the quality of PCa care with the anticipated growing use of this technology,” Dr Leapman’s team concluded.

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The investigators identified study patients using the Surveillance, Epidemiology, and End Results-Medicare database. Of the 8144 patients, 495 (6.1%) underwent prostate MRI. Use of prostate MRI increased from 3.4% in 2010 to 10.5% in 2013. The authors defined observation as the absence of definitive cancer-directed therapy within 12 months of diagnosis.

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Use of prostate MRI has grown and will likely continue to expand, so “the cost-effectiveness of MRI-driven pathways are increasingly relevant to the sustainability of the practice,” they stated.

Obtaining and interpreting MRI studies of the prostate are associated with initial high costs, but economic modeling studies suggest that MRI would be cost-effective if it resulted in increased use of active surveillance for low-risk and very-low-risk PCa, according to Dr Leapman and his team.

He and his collaborators said efforts to facilitate observational approaches for low-risk PCa “are highly valuable to improving the quality of cancer care.”


Leapman MS, Wang R, Park HS, et al. Association between prostate MRI and observation for low-risk prostate cancer. Urology. 2018; published online ahead of print.