Utilization of Prebiopsy Magnetic Resonance Imaging for Prostate Cancer Detection

Background: MRI has emerged as an important tool for prostate cancer early detection. Despite its utility, insurance coverage for prebiopsy MRI is variable, with previous studies suggesting dramatic underutilization. Methods: MarketScan Commercial and Medicare Claims Database was used to identify men who underwent a prostate MRI within 9 months preceding their prostate biopsy from January 2012 to December 2021. Exclusion criteria included a prior prostate cancer (PCa) diagnosis and previous PCa treatment. We examined national trends in MRI utilization according to insurance and prior biopsy status and used multivariable logistic regression to identify predictors of its use. As a supplemental analysis, we explored the probability of treatment with radiation or radical prostatectomy according to prebiopsy MRI status. Results: We identified 252,962 prostate biopsy claims between 2012 and 2021. Prebiopsy MRI use increased from 1.5% of total biopsies to 30.3% in 2021. Among patients who had a prior biopsy, the proportion rose from 2.7% to 59.0%. On multivariable analysis, having undergone a previous biopsy (odds ratio [OR]: 6.04, 95% confidence interval [95% CI]: 5.24 to 6.96; P < .001) and residing in an urban area (OR: 1.95, 95%CI: 1.67-2.28; P < .001) were both independent predictors of having an MRI before biopsy. No differences in the use of prebiopsy MRI were observed between Medicare and commercial insurance holders (OR: 1.07, 95%CI: 0.99-1.15; P = .112). Among patients who had undergone a prior biopsy, the probability of undergoing a subsequent radical prostatectomy was higher for patients who had an MRI before their biopsy (15.9%, 95%CI: 15.0%-16.8%) as compared with patients who did not have a prebiopsy MRI (10.4%, 95%CI: 9.8%-10.9%). Conclusions: The use of prebiopsy MRI for prostate cancer diagnosis has increased over the past decade, particularly in patients who had undergone a prior negative biopsy. Having undergone an MRI was associated with an increase in the odds of treatment, particularly in those with a prior biopsy, suggesting an increase in the detection of higher-grade cancers associated with MRI use at a population level.