A Statewide Intervention Improves Appropriate Imaging in Localized Prostate Cancer

Abstract

An intervention aimed at appropriate use of imaging was associated with decreased use of bone scans and computerized tomography among men at low risk for metastases.

Noninvasive Detection of Clinically Significant Prostate Cancer Using Circulating Tumor Cells

“…In addition more than50% of the patients diagnosed with early stage PCa will not die of the disease [3][4][5][6] suggesting PSA may lead to unnecessary biopsies, over-diagnosis, and overtreatment 7 . Histological grading by Gleason score (GS) from biopsy specimens is currently needed for risk stratification, allowing the offer of appropriate therapeutic options 7,8 . An accurate, non-invasive test for clinically significant PCa (csPCs) might provide a safer, more efficient means of diagnosis.…”

A clinician‐centred programme for behaviour change in the optimal use of staging investigations for newly diagnosed prostate cancer

“…Efforts have been made over the past two decades to reduce the over‐imaging of men with localized, low‐risk prostate cancer, with multiple groups reporting persistent high rates of imaging utilization . The Michigan Urological Surgery Improvement Collaborative has reported extensively on their state‐wide quality improvement collaborative ; they report a decrease in unnecessary imaging, with a marked decrease in variability between practices . The National Prostate Cancer Register of Sweden has reported the results of their nationwide programme to reduce inappropriate imaging requests .…”

R-SCAN: Appropriate Imaging for Low-Risk Prostate Cancer

“…In Sweden, for example, a national effort to educate clinicians on appropriate imaging over a 10-year period led to significantly reduced use, particularly in patients with low-risk prostate cancer (from 45% to 3%) [21]. Similarly, a large group of urologists participating voluntarily in a quality improvement collaborative of diverse practices in Michigan pledged to follow guidelines that included appropriate imaging use in low-risk patients [12]. Baseline assessments were made in 2012 and 2013, with reassessment in 2015, after the interventions.…”

“…Definitions vary, but as an example, the D'Amico criteria classify low-risk prostate cancer as PSA less than or equal to 10 ng/mL, a Gleason sum less than or equal to 6, and clinical stage T1-2a [8]. Many authors note the propensity of patients with low-risk prostate cancer to undergo imaging for systemic staging for metastasis detection [7,[9][10][11][12]. Imaging for metastatic disease in these low-risk individuals has been shown to have such low yields that utility has been called into question [9][10][11].…”