2011 Genitourinary Cancers Symposium
ORLANDO — More than one-third of men at low risk
for prostate cancer underwent unnecessary medical imaging, whereas less than
two-thirds of men at high risk received an imaging test, according to findings
Sandip M. Prasad, MD, of the University of
Chicago Medical Center, and colleagues conducted a study to characterize trends
in radiographic imaging, including bone scan, CT and MRI procedures, in 30,183
men with newly diagnosed prostate cancer.
Unnecessary imaging was used for staging in 36% of men
with low risk and 49% of men with intermediate risk. Only 61% of men in the
high-risk group received any imaging test before treatment.
Being older than 75 years, black, wealthier and living
in rural regions were associated with use of medical imaging. Men who underwent
cryotherapy, proton beam therapy and radiation/brachytherapy also were more
likely to receive medical imaging.
Educated men and those who chose watchful waiting were
less likely to receive medical imaging.
Charlson score and marital status were not linked to
medical imaging use.
“There is widespread overutilization of staging in
low- and intermediate-risk patients, while a worrisome number of men at high
risk undergo treatment without appropriate diagnostic imaging,” the
researchers wrote. “Physicians may be prescribing costly and unnecessary
tests with associated harmful radiation in over one-third of patients, while
forgoing the recommended metastatic workup in almost 40% of high-risk patients
prior to treatment.”
Patients were identified during 2004-2005 using
SEER-Medicare linked data.
For more information:
- Prasad SM. #120. Presented at: 2011 Genitourinary Cancers Symposium;
Feb. 15-19, 2011; Orlando, Fla.
Disclosure: Dr. Prasad reports no relevant financial disclosures.
This study raises the bigger question of how often physicians are
following published guidelines; in this case, for the use of medical imaging.
We want to treat patients in a way that level one evidence dictates, but
unfortunately, this is not always the case. We see it not only in prostate
cancer but in other genitourinary cancers, as well.
This is something that plagues our field. We need to judiciously use
staging by following what is suggested and recommended in the literature.
Hopefully, as we have more systems based in medicine, we can make better use of
There are multiple studies showing that adherence to staging
recommendations is incomplete in the US.
One other point is that patients need to be more aware of the numbers
regarding specific scans. If they knew the data and had the resources to find
out which tests will be beneficial and which would not in their particular
circumstances, they may feel more comfortable not receiving an MRI or a scan.
Physicians need to dispel the feeling patients have that they always need these
procedures. It is incumbent upon the treating physician to provide the data so
the patient can understand why the recommendations are what they are.
For example, if we can tell a patient the exact dose of radiation that
they will receive in that particular CT scan, and then explain that excessive
radiation exposure over the course of a lifetime can increase the risk for
other malignancies, now the conversation changes.
– Dean Bajorin, MD
Professor of medicine
at Memorial Sloan-Kettering Cancer Center
Disclosure: Dr. Bajorin reports no relevant financial