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Quantifying downstream impact of inappropriate staging imaging in a cohort of veterans with low- and intermediate-risk incident prostate cancer. Urol Oncol 2019 02;37(2):145-149

Date

12/24/2018

Pubmed ID

30578160

DOI

10.1016/j.urolonc.2018.11.022

Abstract

INTRODUCTION: According to current National Comprehensive Cancer Network guidelines, routine imagining for staging low-risk prostate cancer is not recommended. However, extensive overuse of guideline-discordant imaging continues to persist. Incidental findings are common on imaging and little is known about the optimal management. Rates of incidental findings vs. false positive diagnosis from inappropriate imaging are poorly understood and have yet to be quantified for low- and intermediate-risk prostate cancer patients.

OBJECTIVE: To determine the frequency of positive radiologic findings in patients with low- and intermediate-risk prostate cancer during initial staging at VA New York Harbor Healthcare System.

METHODS: We retrospectively reviewed all low- and intermediate-risk prostate cancer patients' medical records from the VA New York Harbor Healthcare System for diagnosis from 2005 to 2015. We reviewed each individual's prebiopsy prostate specific antigen (PSA), Gleason score, and clinical stage. We also determined if imaging obtained yielded a false positive, incidental finding, or if metastatic disease occurred within the 6 months following initial diagnosis.

RESULTS: There were 414 men, who were classified as low- to intermediate-risk prostate cancer and underwent inappropriate staging imaging of 4,306 men diagnosed with prostate cancer. Of these 414 men, 178 (43%) had additional follow-up imaging for positive findings. We calculated an incidental finding rate of 10% and a false positive rate of 38% for patients. Five (1%) patients had metastatic disease.

CONCLUSION: Despite guideline recommendations, imaging overuse remains an issue for low-intermediate-risk prostate cancer patients. The false positive rate found in this analysis is alarmingly high at 38%. This use of scans is burdensome to the healthcare system and patient. This study highlights the frequency of inappropriate imaging and its negative consequences.

Author List

Drangsholt S, Walter D, Ciprut S, Lepor A, Sedlander E, Curnyn C, Loeb S, Malloy P, Winn AN, Makarov DV

Author

Aaron Winn PhD Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Biomarkers, Tumor
Humans
Image Processing, Computer-Assisted
Male
Middle Aged
Neoplasm Grading
Neoplasm Staging
Predictive Value of Tests
Prostate-Specific Antigen
Prostatic Neoplasms
Retrospective Studies
Risk Assessment
Tomography, X-Ray Computed
Veterans
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a