The NCCN guidelines do not recommend use of CT and bone scan imaging for metastatic staging of low-risk CaP due to the 1% likelihood of metastasis in this cohort. It is previously reported that imaging is widely overused; for example 22.7% of men with low-risk CaP had inappropriate use of imaging according to a study by Cooperberg. This study characterized patterns of care and factors associated with the use of imaging in men with low-risk CaP.
The study used SEER-Medicare data for analysis of 46,364 men diagnosed with CaP between 2004 and 2005. After exclusions and selection of low-risk men, there were 6,444 subjects remaining for analysis. Corresponding CPT-4 and ICD-9 codes identified treatment choice. Men who had no treatment within 12 months of diagnosis were considered to be on active surveillance.
Use of imaging was greatest among men treated with radiation (45.5%), followed by surgery (26.1%) and active surveillance (12.8%). There was significant geographic variation in the use of imaging among the SEER sites, with New Jersey having the highest rate (61.6%) and Seattle the lowest (18%). A household income of >$60,000 meant a man was more likely to undergo imaging (39.6%) compared with a man from a household with median income <$35,000 (35.6%). Age, race, marital status, year of diagnosis and comorbidity were not associated with imaging use. Compared with surgery, men undergoing radiation had an odds ratio of 1.99 for greater likelihood of imaging. Overall, they found that 36.2% of men had at least one imaging exam; 23.5% had a CT scan and 26.5% had a bone scan. Abdominal ultrasound was performed in 1.8% of men.
Choi WW, Williams SB, Gu X, Lipsitz SR, Nguyen PL, Hu JC
J Urol. 2011 May;185(5):1645-9
10.1016/j.juro.2010.12.033
PubMed Abstract
PMID: 21419444
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