Introduction:

Both the American Urological Association (AUA) and the National Comprehensive Cancer Network (NCCN) do not recommend staging imaging in very low risk (VLR) and low risk (LR) prostate cancer (PCa).  Despite these explicit guidelines, there is concern for overutilization of imaging in these groups. To investigate this, we explored the utilization of staging imaging and the significance of the findings in newly diagnosed VLR and LR PCa patients.

Methods:

493 PCa patients diagnosed between 2011-2017 were stratified according to AUA and NCCN VLR and LR groups. Computed tomography (CT), magnetic resonance imaging (MRI) and bone scan performed at diagnosis was captured and compliance to guidelines was evaluated.The significance of radiologist interpreted imaging findings, by imaging type, were classified as non-urologic, non-significant urologic, and PCa significant.

Results:

Greater than 75% of patients among each of these risk groups underwent imaging at time of diagnosis.  Specifically, a total of 58 (75%) AUAVLR, 67 (75.3%) AUALR, 51 (75%) NCCNVLR, and 74 (75%) NCCNLR had imaging and thus, showed non-compliance with guidelines. Bone scan was performed in up to 30 (30%) of patients with no scans showing PCa-significant findings and the majority being normal (Table).  Six bone scans showed non-urologic findings necessitating further testing.  CT was utilized in up to 38 (38%) of patients, with the majority being normal and only 3 showing PCa-significant findings.  Ten CTs showed non-urologic/non-significant urologic findings causing further evaluation.  MRI was the most utilized scan in low risk groups, occurring in up to 47 (70%) of patients.  Although, the majority were normal, up to 25 scans showed non-significant urologic findings, and only 7 showed PCa significant findings.

Conclusion:

Among VLR and LR PCa patients there is high overutilization of imaging at time of diagnosis despite AUA and NCCN recommendations against use. Most of such imaging yielded minimal PCa significant findings and caused further workup for incidental results.  This exploratory analysis gives awareness that staging imaging in VLR and LR PCa patients may do more harm than good.

Funding: N/A