Chest radiography in patients with early stage prostatic carcinoma. Effect on treatment planning and cost analysis.
OBJECTIVE
An evaluation of the impact of routine preoperative chest radiographs was retrospectively undertaken in a pilot group of 292 patients with prostatic carcinoma who were part of a prospective study of prostate specific antigen screening for prostate carcinoma.


METHODS
Retrospective.


METHODS
Hospital-based outpatients.


METHODS
A cost-effectiveness model was used to assess the value of routine chest radiography in this patient population. Chest radiography findings were categorized into four groups based on follow-up and impact.


RESULTS
Forty-three patients (15 percent) had a total of 45 positive findings on their chest radiographs. No patient had intrathoracic metastases from prostatic carcinoma. Only two patients (both with unsuspected second neoplasms) had findings that impacted on their treatment and one avoided retropubic radical prostatectomy. Total cost was $2,000 (based on Medicare reimbursement), or $14,000 (based on physician and hospital charges).


CONCLUSIONS
Although benefit is small in terms of number of patients affected, clinical impact, in the two patients with significant findings, was great. Although cost-effectiveness cannot be confirmed on the basis of this series, further evaluation of its utility for this application should be undertaken.
Forman
H P
HP
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis.
Fox
L A
LA
Glazer
H S
HS
McClennan
B L
BL
Anderson
D C
DC
Sagel
S S
SS
D000368:Aged; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D006278:Medicare / Q000191:economics*; D010865:Pilot Projects; D011300:Preoperative Care / Q000191:economics; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D013902:Radiography, Thoracic / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States
D017430:Prostate-Specific Antigen