Institutional Variation in MRI Utilization After Prostatectomy for Prostate Cancer: A Multicenter Study.
4 affiliations
- 1Department of Applied Statistics, Kyonggi University, Suwon-si 16227, Republic of Korea.
- 2Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
- 3Institute of Health and Environment, Seoul National University, Seoul 08826, Republic of Korea.
- 4Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul 08826, Republic of Korea.
Abstract
Background/Objectives: Healthcare utilization may vary because of institutional practice patterns and policy context. This study aimed to evaluate institutional variation and clinical factors associated with repeated MRI examinations after prostatectomy and to explore whether cumulative MRI use was associated with overall survival. Methods: This retrospective multicenter study included 3754 patients who underwent prostatectomy for prostate cancer at seven hospitals. Repeated MRI examinations were analyzed using an Andersen-Gill counting-process Cox model with patient-clustered robust variance, and a complementary Poisson model was used to evaluate postoperative temporal patterns and the robustness of the institutional associations. Biochemical recurrence (BCR; postoperative prostate-specific antigen ≥ 0.2 ng/mL) was treated as a time-updated covariate. A separate exploratory Cox model evaluated overall survival. Results: During a median follow-up of 936 days (interquartile range, 432-1687 days), 2027 postoperative MRI examinations were recorded. Repeated postoperative MRI examinations were more frequent at Hospitals 2-7 than at Hospital 1 (average hazard ratios [HRs] over follow-up, 4.083-23.136; all p < 0.001), although the magnitude of these institutional associations varied over postoperative time (joint hospital-by-time interaction, p < 0.001). MRI examinations were also more frequent after BCR (HR, 1.565; 95% confidence interval [CI], 1.371-1.786; p < 0.001). Grade group and pathological T stage were not significantly associated with repeated MRI use. The annual MRI rate decreased from 18.08 per 100 person-years in postoperative year 5 to 5.94 in year 6. In the exploratory survival analysis, cumulative MRI use was not significantly associated with overall survival (HR, 0.782; 95% CI, 0.564-1.086; p = 0.142). Conclusions: MRI utilization after prostatectomy varied substantially across institutions and over postoperative time, with a marked decline after postoperative year 5. Although MRI examinations were more frequent after BCR, the large institutional differences were not fully explained by the measured clinical factors. These findings highlight the need for more standardized and evidence-based criteria for MRI use after prostatectomy.
Related
- Comparative outcomes of radical prostatectomy, radiotherapy, and radiotherapy plus androgen deprivation therapy for high-risk and very high-risk prostate cancer: a narrative review
- Feasibility and early outcomes of salvage robot-assisted radical prostatectomy after focal therapy failure for localized prostate cancer
- PSMA PET/CT-guided salvage elective nodal radiotherapy for nodal metastases after radical prostatectomy: a bi-institutional long-term outcome analysis
- Surgical Team Composition and Outcomes After Radical Prostatectomy for Prostate Cancer.
- Results of radical prostatectomy and short-term follow-up of men with ISUP GG 1 and 2 prostate cancer who underwent magnetic resonance imaging-guided active surveillance.
BibTeX
@article{lee2026institutional,
title = {{Institutional Variation in MRI Utilization After Prostatectomy for Prostate Cancer: A Multicenter Study.}},
author = {Seungjae Lee and Moon Hyung Choi and Hokun Kim and Dong Jin Chung and Su Lim Lee and Yeon Soo Lim and Hyun A Kim and Geon Park and Woojoo Lee},
journal = {Healthcare (Basel, Switzerland)},
year = {2026},
month = sep,
doi = {10.3390/healthcare14193131},
url = {https://europepmc.org/article/MED/42881570},
note = {CC BY},
}
RIS
TY - JOUR
TI - Institutional Variation in MRI Utilization After Prostatectomy for Prostate Cancer: A Multicenter Study.
AU - Seungjae Lee
AU - Moon Hyung Choi
AU - Hokun Kim
AU - Dong Jin Chung
AU - Su Lim Lee
AU - Yeon Soo Lim
AU - Hyun A Kim
AU - Geon Park
AU - Woojoo Lee
PY - 2026
DA - 2026/09/22
JO - Healthcare (Basel, Switzerland)
DO - 10.3390/healthcare14193131
UR - https://europepmc.org/article/MED/42881570
AB - Background/Objectives: Healthcare utilization may vary because of institutional practice patterns and policy context. This study aimed to evaluate institutional variation and clinical factors associated with repeated MRI examinations after prostatectomy and to explore whether cumulative MRI use was associated with overall survival. Methods: This retrospective multicenter study included 3754 patients who underwent prostatectomy for prostate cancer at seven hospitals. Repeated MRI examinations were analyzed using an Andersen-Gill counting-process Cox model with patient-clustered robust variance, and a complementary Poisson model was used to evaluate postoperative temporal patterns and the robustness of the institutional associations. Biochemical recurrence (BCR; postoperative prostate-specific antigen ≥ 0.2 ng/mL) was treated as a time-updated covariate. A separate exploratory Cox model evaluated overall survival. Results: During a median follow-up of 936 days (interquartile range, 432-1687 days), 2027 postoperative MRI examinations were recorded. Repeated postoperative MRI examinations were more frequent at Hospitals 2-7 than at Hospital 1 (average hazard ratios [HRs] over follow-up, 4.083-23.136; all p < 0.001), although the magnitude of these institutional associations varied over postoperative time (joint hospital-by-time interaction, p < 0.001). MRI examinations were also more frequent after BCR (HR, 1.565; 95% confidence interval [CI], 1.371-1.786; p < 0.001). Grade group and pathological T stage were not significantly associated with repeated MRI use. The annual MRI rate decreased from 18.08 per 100 person-years in postoperative year 5 to 5.94 in year 6. In the exploratory survival analysis, cumulative MRI use was not significantly associated with overall survival (HR, 0.782; 95% CI, 0.564-1.086; p = 0.142). Conclusions: MRI utilization after prostatectomy varied substantially across institutions and over postoperative time, with a marked decline after postoperative year 5. Although MRI examinations were more frequent after BCR, the large institutional differences were not fully explained by the measured clinical factors. These findings highlight the need for more standardized and evidence-based criteria for MRI use after prostatectomy.
SN - 2227-9032
ER -