DOI QR코드

DOI QR Code

Feedback on Baseline Use of Staging Images is Important to Improve Image Overuse with Newly Diagnosed Prostate Cancer Patients

  • Sawazaki, Harutake (Department of Urology, Japanese Red Cross Otsu Hospital) ;
  • Sengiku, Atsushi (Department of Urology, Japanese Red Cross Otsu Hospital) ;
  • Imamura, Masaaki (Department of Urology, Japanese Red Cross Otsu Hospital) ;
  • Takahashi, Takeshi (Department of Urology, Japanese Red Cross Otsu Hospital) ;
  • Kobayashi, Hisato (Department of Radiology, Japanese Red Cross Otsu Hospital) ;
  • Ogura, Keiji (Department of Urology, Japanese Red Cross Otsu Hospital)
  • Published : 2014.02.28

Abstract

Background: The objective of this study was to evaluate baseline use and positive rates of staging images (bone scan, CT) in newly diagnosed patients with prostate cancer (PCa) and to improve staging image overuse. Materials and Methods: This retrospective study covered a consecutive series of patients with PCa who underwent stage imaging at our institution between 2006 and 2011. Various clinical and pathological variables (age, PSA, biopsy Gleason score, clinical T stage, positive biopsy core rate) were evaluated by multivariate logistic regression analysis for their ability to predict a positive staging image. All patients were stratified according to the NCCN risk stratification and positive rates were compared in each risk group. Results: 410 patients (100%) underwent a bone scan and 315 patients (76.8%) underwent a CT scan. Some 51 patients (12.4%) had a positive bone scan, clinical T3 and T4 being significant independent predictors. Positive bone scan rates for low-, intermediate-, high-, and very high-risk groups were 0%, 0%, 8.25%, and 56.6%. Some 59 (18.7%) patients had a positive CT scan, with elevated PSA and clinical T3, T4 as significant independent predictors. Low-, intermediate-, high- and very high-risk group rates were 0%, 0%, 13.8% and 80.0%. Conclusions: The incidences of positive staging image in low- and intermediate- risk group were reasonably low. Following feedback on these results, staging in low- and intermediate- risk groups could be omitted.

Keywords

Prostate cancer;staging image;baseline use;feedback;risk stratification

References

  1. Borin JF (2011). Imaging for staging prostate cancer-too much or not enough? J Urol, 186, 779-80. https://doi.org/10.1016/j.juro.2011.07.039
  2. Choi WW, Williams SB, GuX, et al (2011). Overuse of imaging for staging low risk prostate cancer. J Urol, 185, 1645-9. https://doi.org/10.1016/j.juro.2010.12.033
  3. Ito K, Kakehi Y, Naito S, et al (2008). Japanese urological association: japanese urological association guidelines on prostate-specific antigen-based screening for prostate cancer and the ongoing cluster cohort study in Japan. Int J Urol, 15, 763-8. https://doi.org/10.1111/j.1442-2042.2008.02125.x
  4. Lavery HJ, Brajtoord JS , LevinsonAW, et al (2011). Unnecessary imaging for the staging of low-risk prostate cancer is common. Urol, 77, 274-78. https://doi.org/10.1016/j.urology.2010.07.491
  5. Miller DC, Murtagh DS, Suh RS, et al (2011). Regional collaboration to improve radiographic staging practices among men with early stage prostate cancer. J Urol, 186, 844-9. https://doi.org/10.1016/j.juro.2011.04.078
  6. Palvolgyi R, Daskivich TJ, Chamie K, Kwan L, Litwin MS (2011). Bone scan overuse in staging of prostate cancer: an analysis of a Veterans Affairs cohort. Urology, 77, 1330-6. https://doi.org/10.1016/j.urology.2010.12.083
  7. Sanjaya IPG, Mochtar CA, Umbas R (2013). Correlation between low Gleason score and prostate specific antigen levels with incidence of bone metastases in prostate cancer patients: when to omit bone scans? Asian Pac J Cancer Prev, 14, 4973-4976 https://doi.org/10.7314/APJCP.2013.14.9.4973

Cited by

  1. Overuse of Health Care Services in the Management of Cancer vol.55, pp.7, 2017, https://doi.org/10.1097/MLR.0000000000000734