Prostate Cancer Smart Surgery Treatment Trifecta

Overutilization of Imaging

July 2010

Unnecessary Imaging for the Staging of Low-Risk Prostate Cancer Is Common.


Hugh J. Lavery, Jonathan S. Brajtbord, Adam W. Levinson, Fatima Nabizada-Pace, Matthew E. Pollard, and David B. Samadi.

Objective
International evidence-based best practice guidelines discourage routine imaging for staging purposes in low-risk patients with newly diagnosed prostate cancer. We quantified the rate of overuse of preoperative imaging procedures in a referral cohort of low-risk patients.

Materials and Methods
An institutional database comprised of all patients undergoing robotic-assisted laparoscopic prostatectomy was queried for “low-risk” patients between May 2005 and January 2010. “Lowrisk” was defined by the most inclusive criteria for imaging recommendations: prostate-specific antigen 10 ng/mL and Gleason score 6. We defined staging imaging as a bone scan, computed tomography (CT) of the pelvis or endorectal magnetic resonance imaging performed after the diagnosis of prostate cancer and before prostatectomy for the indication of “prostate cancer.” Six-hundred seventy-seven patients were identified as having low-risk disease and comprised our study population.

Results
Of the 677 patients identified as low risk, 328 (48%) underwent at least one preoperative imaging procedure despite the guideline recommendations. Two-hundred two of 677 (30%) patients were administered at least 2 of the 3 modalities, and 18/677 (3%) patients received all 3 imaging examinations before prostatectomy. Suspicious results from the CT (7/265%, 2.7%) or bone scan (21/241%, 8.7%) resulted in 27 patients undergoing additional radiographic imaging, none of which resulted in suspicious lesions requiring intervention or biopsy.

Conclusions
Despite international evidence-based guidelines for the staging of newly diagnosed prostate cancer patients, many urologists continue to refer low-risk patients for unnecessary imaging studies. This may place the patient at increased risk from radiation or contrast exposure and
places an unnecessary financial burden on the patient and health care system.