Association Between Guideline-Discordant Prostate Cancer Imaging Rates and Health Care Service Among Veterans and Medicare Recipients

Abstract

This cohort study compares receipt of National Comprehensive Cancer Network (NCCN) guideline–discordant prostate cancer imaging (radionuclide, CT, or MRI) to stage incident prostate cancer among men being treated in the Veterans Health Administration system vs those receiving Medicare-covered services vs a combination of the two.

The cost, survival, and quality‐of‐life implications of guideline‐discordant imaging for prostate cancer

“…Prior work has quantified inappropriate imaging rates as high as 53% for low-risk prostate cancer patients in a U.S. Medicare setting. 24 This underscores the strong need and demand for the present analysis as a novel investigation documenting the cost-benefit trade-offs.…”

“…Prior work has quantified inappropriate imaging rates as high as 53% for low‐risk prostate cancer patients in a U.S. Medicare setting. 24 This underscores the strong need and demand for the present analysis as a novel investigation documenting the cost‐benefit trade‐offs. Additionally, in settings with lower rates of inappropriate imaging of low‐risk patients, there usually exists similarly lower rates of appropriate imaging for high‐risk patients.…”

“…1 Despite these clear guidelines, inappropriate imaging of men with prostate cancer remains prevalent. 2 While imaging may yield useful additional information for some patients, for many imaging has a low probability of influencing treatment choices, and therefore, its harms outweigh its benefits. 3 , 4 Harms include emotional distress, wasteful spending, and increased cancer risk secondary to radiation exposure.…”

Prostate Cancer in Transgender Women in the Veterans Affairs Health System, 2000-2022

“…Although limited numbers precluded formal statistical comparisons, transgender women receiving estrogen at diagnosis had the most aggressive disease (highest PSA density and proportion of biopsy grade group 5), suggesting delayed diagnosis or early selection of cancer cells resistant to androgen deprivation, which tend to be more aggressive. Among transgender women, 25% overall and 35% receiving estrogen had biopsy grade group 4 or 5 vs only 16% among cisgender male veterans . Only 8% of transgender women with prostate cancer vs 29% of cisgender male veterans with prostate cancer were Black, suggesting additional disparities at the intersection of race and gender identity.…”

Improving Guideline Adherence in Urology

“…In another example, studies on imaging for men with prostate cancer estimated that around 50% of men in the US received guideline discordant imaging [41], and up to 70% received guideline discordant imaging in Italy. [42] Makarov et al investigated the reasons for guideline discordant use of imaging to stage incident prostate cancer using a qualitative study design grounded in behavioural theory and implementation science.…”