The availability of prostate magnetic resonance imaging (MRI) and genomic testing is associated with increased adoption of observation rather than treatment as an initial management strategy for localized prostate cancer, according to new study findings. But some US regions are lagging behind in their uptake of these risk stratification tools.

Investigators examined claims for prostate MRI and genomic testing among 65,530 commercially insured patients (aged 40-89 years) diagnosed with prostate cancer. They compared an early period (July 2012 to June 2014, before widespread availability of these technologies) to a later period (July 2017 to June 2019) when these technologies came into wider use.

Use of prostate MRI increased significantly from 7.2% to 16.7% and use of genomic testing from 1.3% to 12.7% from the early to late period, Michael S. Leapman, MD, of Yale University School of Medicine in New Haven, Connecticut, and colleagues reported in JAMA Network Open.

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The investigators ranked US hospital referral regions by their uptake of prostate MRI and genomic testing. Compared with the lowest quartile, the highest quartile of prostate MRI and genomic testing uptake had significant 4.1% and 2.5% absolute increases in the proportion of patients receiving observation, respectively.

“Prostate MRI is a staging and diagnostic tool that enhances estimates of cancer grade and stage, whereas genomic tests provide prognostic estimates that are derived from observed associations with disease outcome,” Dr Leapman’s team explained.

“The findings of this study suggest that adoption of technologies designed to improve decision-making may lead to perceivable reductions in overtreatment of prostate cancer.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Leapman MS, Wang R, Park HS, et al. Adoption of new risk stratification technologies within US hospital referral regions and association with prostate cancer management. JAMA Netw Open. Published online October 8, 2021. doi:10.1001/jamanetworkopen.2021.28646