Introduction:
Utilization of staging imaging in men diagnosed with prostate cancer has shifted over time with updated clinical guidelines and practices, resulting in changes in both the imaging modalities used and rates of imaging by risk group. The purpose of this study is to evaluate imaging use in men with newly diagnosed prostate cancer by modality and risk group, with a focus on implications for low-value care.
Methods:
Surveillance, Epidemiology, and End Results (SEER) linked to Medicare data from 2007 to 2015 were analyzed to establish rates of imaging use in men diagnosed with prostate cancer, and to evaluate differences in these rates by prostate cancer risk groups. The association of receipt of low-value staging imaging per guidelines was evaluated for all encounters using multivariable logistic regression models adjusted for patient factors. Low-value imaging was defined as receipt of a bone-scan or CT scan in low-risk disease and lack of advanced imaging in high-risk. P-values less than 0.05 were considered as statistically significant.
Results:
While overall utilization of imaging remained largely unchanged, there were differences by cancer risk. Imaging use decreased most in low-risk patients, with computerized tomography (CT) decreasing from 41.4% to 30.4% and bone scan use from 36.9% to 11.4%. Utilization of all imaging types was found to increase in high-risk patients. Logistic regression models found that in low-risk patients, risk for inappropriate imaging increased with increasing Charleston Comorbidity Index score (CCI). Patients who did not receive initial curative treatment were less likely to receive low-value imaging as compared to those undergoing prostatectomy (OR 0.74). In men diagnosed with high-risk cancer, the likelihood of low-value imaging decreased with increasing CCI increasing Gleason Grade Group, and clinical stage. Men undergoing androgen deprivation therapy or forgoing initial treatment were at higher risk for low-value imaging (OR 1.68 and 1.99, respectively). In both groups there was no trend in risks associated with year of diagnosis.
Conclusion:
Current guidelines do not recommend CT or bone scan imaging in low risk local prostate cancer patients, with regular use recommended in some intermediate and all high-risk patients. This study found that imaging use surrounding prostate cancer diagnosis has changed over time. While the trends appear to move towards improving value, rates of CT and bone scan use in low risk patients are still remarkable and appropriate imaging use in high-risk patients remains inadequate. Logistic regression models found several inverse trends in appropriate imaging use between high and low risk groups. These findings suggest there are different factors driving utilization of imaging between groups, despite the presence professional organization recommendations. Current initiatives to increase the value of imaging appear to be having a modest effect but suggest continued opportunities for meaningful improvement, which may not be the same for every risk group.
Funding: K08CA234431
Image(s) (click to enlarge):
UPDATED IMAGING TRENDS IN MEN WITH NEWLY DIAGNOSED PROSTATE CANCER
Category
Prostate Cancer > Other
Description
Poster #158
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Presented By: Suzanne M Lange, MD
Authors:
Suzanne M Lange, MD
Mouneeb Choudry
Jacob Ambrose
William Lowrance, MD MPH MBA
Heidi Hanson, PhD
Brock O'Neil, MD