Researchers who studied a group of Veterans Affairs (VA) patients with low-risk prostate cancer (PCa) reported finding extensive overuse of bone scans for PCa staging, creating unnecessary patient anxiety and economic waste for the VA system.
Roland Palvolgyi, MD, of the David Geffen School of Medicine at the University of California in Los Angeles, and his colleagues reviewed the charts of 1,598 PCa patients treated at VA facilities in Southern California. The mean age of the men at diagnosis was 67.3 years.
Of 519 men with low-risk disease, 132 (25%) underwent bone scans; none had positive findings. Only a PSA level of 20 ng/mL or higher, clinical stage cT3 or higher, and a Gleason score of 7 or higher corresponded with positivity. A bone scan positivity rate of 10% or greater was limited to men with a PSA level of 20 ng/mL or greater, clinical stage cT3 or higher, or Gleason score of 8 or higher. Study findings appear in Urology (published online ahead of print).
As a result of study limitations, including the retrospective study design and analysis of data derived only from VA sites in Southern California, the findings might not be generalizable to urology practices outside the VA system, the researchers pointed out.
Still, the findings suggest that contemporary practice patterns may fall short of adherence to established guidelines for bone scan imaging in PCa, they observed. This is of particular concern because of the expense of a bone scan (one estimate put the mean cost at $650 per scan). Another concern is the significant proportion of patients who also undergo additional confirmatory imaging procedures such as computed tomography and magnetic resonance scans, “further increasing the cost [of treatment] and exposing patients to unnecessary radiation.”
Guidelines from the American Urological Association state that bone scans should be reserved for patients presenting with one or more of the following criteria: PSA level of 20 or greater ng/mL, clinical stage T3a or greater, Gleason score of 8 or higher or boney pain on examination.