Wayne State University School of Medicine, Detroit, Michigan.
Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan.
Cancer Med. 2019 Jul;8(8):3659-3665. doi: 10.1002/cam4.2149. Epub 2019 May 21.
Magnetic resonance imaging is playing an ever-bigger role in the management of prostate cancer. This study investigated barriers to obtaining multi-parametric MRI (mpMRI) in African-American men on active surveillance for prostate cancer in comparison to white men affected by the same type of cancer.
Retrospective review of prostate mpMRI orders from August 2015 to October 2017 at a single health organization treating a diverse population was performed. Data was extracted from the electronic medical records and cancellations were examined based on the documented reason for mpMRI cancellation, race, median zip code household income, and distance from healthcare facility.
Out of 793 prostate mpMRI orders, 201 (25%) went unscanned. Access to care issues accounted for 46% of unscanned orders. Patient cancellations were the most common, followed by difficulty contacting patients, and insurance denials. African-American patients disproportionately went unscanned because institution staff were unable to contact patients (29% vs 10% in white men, P = 0.0015). Median zip code household income was significantly different between racial groups but did not vary between indication for cancellation.
African-American prostate cancer patients' access to mpMRI is hindered more by barriers to care than White patients. Urology providers must consider these issues before using prostate mpMRI within their active surveillance pathways.
磁共振成像（MRI）在前列腺癌的管理中发挥着越来越重要的作用。本研究调查了在接受前列腺癌主动监测的非裔美国男性中，与患有同种癌症的白人男性相比，获得多参数 MRI（mpMRI）的障碍。
对单一医疗机构 2015 年 8 月至 2017 年 10 月期间的前列腺 mpMRI 订单进行回顾性审查，该医疗机构治疗的患者人群多样化。从电子病历中提取数据，并根据 mpMRI 取消的记录原因、种族、中位数邮政编码家庭收入和距医疗机构的距离来检查取消情况。
在 793 份前列腺 mpMRI 订单中，有 201 份（25%）未进行扫描。就诊相关问题占未扫描订单的 46%。患者取消是最常见的原因，其次是难以联系患者和保险拒付。由于机构工作人员无法联系到患者，非裔美国患者的 mpMRI 未得到扫描的比例不成比例（29%比白人男性的 10%，P=0.0015）。种族群体之间的邮政编码中位数家庭收入存在显著差异，但与取消的原因无关。
与白人患者相比，非裔美国前列腺癌患者接受 mpMRI 的障碍更多是由于就诊障碍。泌尿科医生在将前列腺 mpMRI 用于其主动监测路径之前，必须考虑这些问题。
