Imaging Guidelines for PCa Staging Often Not Followed

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ORLANDO—Radiographic imaging studies often are used inappropriately for men with newly diagnosed prostate cancer (PCa), with certain patients undergoing unnecessary imaging and others not receiving imaging even though it is recommended, researchers concluded.

Guidelines issued by the American Urological Association and the National Comprehensive Cancer Network recommend radiographic imaging for PCa staging only for patients with high-risk pathologic features. Yet, a team led by Sandip M. Prasad, MD, a Society of Urologic Oncology Fellow at the University of Chicago Medical Center, found that 36% and 49% of men with low- and intermediate-risk PCa, respectively, underwent radiographic imaging for cancer staging. Meanwhile, of the men with high-risk disease—for whom imaging studies are recommended—39% did not undergo imaging, a finding that Dr. Prasad said was surprising because many of these patients received curative local therapy.

Dr. Prasad, who presented study findings at the fourth annual Genitourinary Cancers Symposium, noted that imaging use was more common in men who were older than 75 years or black, had higher incomes, or underwent radiation therapies. Imaging use was less common in better educated men and those who chose to undergo active surveillance.

Regarding the overuse of imaging in men with low- and intermediate-risk PCa, Dr. Prasad speculated that clinicians may order tests to assure anxious patients that the cancer has not spread and possibly as a malpractice defense.

For the study, Dr. Prasad's team used the Surveillance, Epidemiology, and End Results-Medicare Linked database to identify 30,183 men diagnosed with PCa from 2004 to 2005. Of these, 9,640 had low-risk risk disease, 12,966 had intermediate-risk disease, and 7,577 had high-risk disease.

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