Disparities in MRI and TRUS for prostate cancer detection: A systematic review and meta-analysis of 94,020 cases

Prostate cancer (PC) is one of the most prevalent cancers and is the second leading cause of cancer death in men. Recent evidence has demonstrated racial disparities in imaging utilization and, as a result, PC diagnosis.

The goal of this systematic review and meta-analysis was to quantify the disparity in utilization of Magnetic Resonance Imaging (MRI) and Transrectal Ultrasound (TRUS) for PC diagnosis among different races (Whites, Blacks, Asians, Caucasians, Hispanics, and other races). Our study, however, focuses on disparities observed in the North American population, as most of the studies included were carried out in Canada and the United States.

We carried out a systematic search in Google Scholar, PubMed/Medline, Web of Science, Scopus, and EMBASE databases. A total of 33 relevant articles published before August 2024 were included. We used Stata version 15 for statistical analysis. I² statistics was employed to assess heterogeneity. Egger and Begg's tests evaluated any publication bias.

A total of 33 articles collectively contained 94,020 cases with a mean age of 77.9 across six defined races (African-American or Black, White, Asians, Caucasians, Hispanics, and other races). Analysis demonstrated greater utilization of MRI in White patients 66 % (95 % CI: 0.59-0.73; I2 = 99.5 %),19 % (95 % CI: 0.17-0.22; I2 = 98.95 %) in Blacks, 67 % (95 % CI: 0.56-0.78; I2 = 98.99 %) in Caucasians, 7 % (95 % CI: 0.04-0.09; I2 = 97.55 %) in Hispanics, 4 % (95 % CI: 0.03-0.05; I2 = 86.53 %) in Asians, and 24 % (95 % CI: 0.11-0.37; I2 = 99.94 %) in other races. Also, relatively low utilization of TRUS was demonstrated in Black patients at 30 % (95 % CI: 0.15-0.44, I2=99.75 %) CONCLUSION: This systematic review and meta-analysis demonstrate a higher utilization of MRI for PC diagnosis in White patients relative to Blacks, Hispanics, and Asians, respectively. In addition, the use of TRUS in the Black population is relatively limited. These outcomes indicate a need for a change in radiologic utilization and health policies.