The Population Level Prevalence and Correlates of Appropriate and Inappropriate Imaging to Stage Incident Prostate Cancer in the Medicare Population

Abstract

We found poor adherence to imaging guidelines for men with incident prostate cancer. Understanding the patterns by which clinicians use imaging for prostate cancer should guide educational efforts as well as research to suggest evidence-based guideline improvements.

Differential post-prostatectomy cancer-specific survival of occult T3 vs. clinical T3 prostate cancer: Implications for managing patients upstaged on prostate magnetic resonance imaging

“…Many randomized trials for the treatment of prostate cancer included or excluded patients based on a combination of clinical T stage, PSA, and Gleason score in an era when pelvic MRI was very uncommonly used for staging (0.9%-4.0% of cases [18,19]) and was less accurate for the detection of occult T3 disease [20,21]. These trials suggested an important difference in the management of patients with ADT based on their clinical T stage [22].…”

Prostate Cancer Registries: Current Status and Future Directions

“…Data from registries can provide important insights into clinical guideline adherence among physicians practicing in a certain geographic area or included in a prospective registry [71][72][73][74][75]. Chen et al [72] demonstrated that substantial discordance exists in the SEER-Medicare regarding adoption of the National Comprehensive Cancer Network guidelines for patients with high-risk PCa according to age at diagnosis.…”

Practice Patterns and Predictors of Followup Imaging after a Negative Bone Scan in Men with Castration Resistant Prostate Cancer: Results from the SEARCH Database

“…These observations are consistent with prior literature suggesting that imaging in men newly diagnosed with PC is over used in those at low risk 2e7 and under used in those at high risk. 2,4,7 This has implications for costs and for patient health. Based on our observations, PSADT is clearly associated with imaging frequency but not at the optimal level.…”

“…Studies of imaging patterns in patients newly diagnosed with PC suggest overuse in those at low risk 2e7 and underuse in those at high risk. 2,4,7 Therefore, we evaluated the timing of imaging for metastasis in men with M0 CRPC in the SEARCH (Shared Equal Access Regional Cancer Hospital) database. Specifically in patients with a negative bone scan after CRPC diagnosis we determined which factors predict time to a second imaging test (primary outcome) or time to a second bone scan (secondary outcome) and how this correlates with known predictors of positive imaging tests.…”