SES AUA 2022: Racial Variation in MRI-Guided Prostate Biopsy Significant Cancer Detection Among Black and White Men

(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a prostate cancer session and Dr. Callan Brownfield discussing racial variation in MRI-guided prostate biopsy significant cancer detection among Black and White men. Prostate biopsies guided by MRI have superior cancer detection rates compared to traditional ultrasound-only guided biopsies. The objective of this study was to evaluate comparative cancer detection of MRI-guided prostate biopsies based on self-reported patient race (White versus Black).


This study evaluated Black and White men who had a prostate biopsy within 3 months of a z (September 2018 to June 2020) at a single institution. Patients were excluded if they had no suspicious MRI lesion, had prior prostate surgery, were on prior finasteride therapy, or had missing data on race. The outcome of interest was detection of Grade Group 2+ cancer on biopsy. Bivariate statistics were used to test for significant associations between outcome and exposure and other patient factors.

There were 245 men identified in the analytic cohort, including 79 Black men (32%). The groups were similar in average age (64 years Black vs 66 years White, p=0.18) and PSA level (8.1 ng/mL Black vs 7.0 ng/mL White, p = 0.17). Black men did not have a greater proportion of MRIs with anterior lesions (19% vs 22% White men, p=0.54). Overall, 201 men (82%) had combined systematic plus targeted sampling. A greater proportion of Black men had Grade Group 2+ cancer overall compared to White men (59% vs 49% White, p = 0.10) particularly among biopsy naïve men (n=107; 71% vs. 48% White, p = 0.03):

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Among men who had combined sampling, a greater proportion of Black men had targeted sampling that “missed” Grade Group 2+ found on systematic biopsy (16% vs 7% White men, adjusted OR 0.31, 95% CI 0.11 – 0.85):

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This difference was most striking among biopsy naïve men (29% vs. 11% White men, p = 0.03).

Dr. Brownfield concluded his presentation assessing racial variation in MRI-guided prostate biopsy significant cancer detection among Black and White men with the following take-home messages:

  • Through this institutional experience with MRI-ultrasound fusion image-guided prostate biopsies, Black men were more likely to have significant cancer on systematic sampling that would be missed by targeting of lesions alone
  • Using a “targeted-only” approach for sampling would have missed a significant number of higher-grade cancers among Black men who were biopsy naïve or had a prior negative biopsy
  • Whether this variation is due to patient, radiographic, or provider factors deserves exploration among a larger cohort of men

Presented by: Callan Brownfield, Department of Urology, Emory University, Atlanta, GA

Co-Authors: Reza Nabavizadeh, MD, Jonathan Li, MD, Adeboye Osunkoya, MD, Lara Harik, MD, Brendan Browne, MD, Charles Lorentz, MD, Kenneth Ogan, MD, Cara Cimmino, MD, Melina Pectasides, MD, Amir Davarpanahfakr, MD, Dattatraya Patil, MBBS, MPH, Christopher Filson, MD, MS

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 86th Annual Meeting of the Southeastern Section of the American Urological Association, San Juan, PR, Mar 16 – 19, 2022