Overuse of Imaging for Staging Low Risk Prostate Cancer

No AccessJournal of UrologyAdult Urology1 May 2011Overuse of Imaging for Staging Low Risk Prostate Cancer Wesley W. Choi, Stephen B. Williams, Xiangmei Gu, Stuart R. Lipsitz, Paul L. Nguyen, and Jim C. Hu Wesley W. ChoiWesley W. Choi Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts , Stephen B. WilliamsStephen B. Williams Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts , Xiangmei GuXiangmei Gu Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts , Stuart R. LipsitzStuart R. Lipsitz Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts , Paul L. NguyenPaul L. Nguyen Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts , and Jim C. HuJim C. Hu Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts View All Author Informationhttps://doi.org/10.1016/j.juro.2010.12.033AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Routine imaging for staging low risk prostate cancer is not recommended according to current guidelines. We characterized patterns of care and factors associated with imaging overuse. Materials and Methods: We used SEER-Medicare linked data to identify men diagnosed with low risk prostate cancer from 2004 to 2005, and determined if imaging (computerized tomography, magnetic resonance imaging, bone scan, abdominal ultrasound) was obtained following prostate cancer diagnosis before treatment. Results: Of the 6,444 men identified with low risk disease 2,330 (36.2%) underwent imaging studies. Of these men 1,512 (23.5%), 1,710 (26.5%) and 118 (1.8%) underwent cross-sectional imaging (computerized tomography or magnetic resonance imaging), bone scan and abdominal ultrasound, respectively. Radiation therapy vs surgery was associated with greater odds of imaging (OR 1.99, 95% CI 1.68–2.35, p <0.01), while active surveillance vs surgery was associated with lower odds of imaging (OR 0.44, 95% CI 0.34–0.56, p <0.01). Associated with increased odds of imaging was median household income greater than $60,000 (OR 1.41, 95% CI 1.11–1.79, p <0.01), and men from New Jersey vs San Francisco (OR 3.11, 95% CI 2.24–4.33, p <0.01) experienced greater odds of imaging. Men living in areas with greater than 90% vs less than 75% high school education experienced lower odds of imaging (OR 0.76, 95% CI 0.6–0.95, p = 0.02). Conclusions: There is widespread overuse and significant geographic variation in the use of imaging to stage low risk prostate cancer. Moreover treatment associated variation in imaging was noted with the greatest vs lowest imaging use observed for radiation therapy vs active surveillance. References 1 : Cancer statistics, 2009. CA Cancer J Clin2009; 59: 225. Google Scholar 2 : Outcome based staging for clinically localized adenocarcinoma of the prostate. J Urol1997; 158: 1422. 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Google Scholar © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByLoloi J, Eccles J, Owens G, Lehman E, Kaag M, Raman J and Merrill S (2021) Diagnostic Imaging in Low-Risk Prostate Cancer: More Harm Than Good?Urology Practice, VOL. 9, NO. 2, (134-139), Online publication date: 1-Mar-2022.Sampurno F, Zheng J, Di Stefano L, Millar J, Foster C, Fuedea F, Higano C, Huland H, Mark S, Moore C, Richardson A, Sullivan F, Wenger N, Wittmann D and Evans S (2018) Quality Indicators for Global Benchmarking of Localized Prostate Cancer ManagementJournal of Urology, VOL. 200, NO. 2, (319-326), Online publication date: 1-Aug-2018.Ross I, Womble P, Ye J, Linsell S, Montie J, Miller D and Cher M (2018) MUSIC: Patterns of Care in the Radiographic Staging of Men with Newly Diagnosed Low Risk Prostate CancerJournal of Urology, VOL. 193, NO. 4, (1159-1162), Online publication date: 1-Apr-2015.Sourbeer K, Howard L, Moreira D, Amarasekara H, Chow L, Cockrell D, Hanyok B, Pratson C, Kane C, Terris M, Aronson W, Cooperberg M, Amling C, Hernandez R and Freedland S (2018) Practice Patterns and Predictors of Followup Imaging after a Negative Bone Scan in Men with Castration Resistant Prostate Cancer: Results from the SEARCH DatabaseJournal of Urology, VOL. 193, NO. 4, (1232-1238), Online publication date: 1-Apr-2015.Hussein A, Punnen S, Zhao S, Cowan J, Leapman M, Tran T, Washington S, Truesdale M, Carroll P and Cooperberg M (2018) Current Use of Imaging after Primary Treatment of Prostate CancerJournal of Urology, VOL. 194, NO. 1, (98-104), Online publication date: 1-Jul-2015.Taneja S (2018) Re: Prostate Cancer Imaging Trends after a Nationwide Effort to Discourage Inappropriate Prostate Cancer ImagingJournal of Urology, VOL. 191, NO. 5, (1287-1288), Online publication date: 1-May-2014.Makarov D, Desai R, Yu J, Sharma R, Abraham N, Albertsen P, Penson D and Gross C (2018) The Population Level Prevalence and Correlates of Appropriate and Inappropriate Imaging to Stage Incident Prostate Cancer in the Medicare PopulationJournal of Urology, VOL. 187, NO. 1, (97-102), Online publication date: 1-Jan-2012. Volume 185Issue 5May 2011Page: 1645-1649 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordsdiagnostic imagingprostatic neoplasmshealth services misusehealth expendituresMetricsAuthor Information Wesley W. Choi Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Stephen B. Williams Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Supported by the Robert and Kathy Salipante Minimally Invasive Urologic Oncology Fellowship. More articles by this author Xiangmei Gu Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Stuart R. Lipsitz Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Paul L. Nguyen Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts More articles by this author Jim C. Hu Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts Recipient of Department of Defense Physician Training Award W81XWH-08-1-0283. More articles by this author Expand All Advertisement PDF DownloadLoading ...