Contemporary trends in imaging test utilization for prostate cancer staging: data from the cancer of the prostate strategic urologic research endeavor.
OBJECTIVE
Previous investigators have reported widespread overuse of imaging tests for staging clinically localized prostate cancer. In this study imaging test utilization rates were analyzed in a contemporary group of patients, and clinical and demographic predictors of testing were identified.


METHODS
Data were abstracted from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a longitudinal registry of men with various stages of prostate cancer. A total of 4,966 men met study inclusion criteria of available treatment and staging data. The rates of computerized tomography, magnetic resonance imaging and bone scans performed between the dates of diagnosis and primary treatment were analyzed in patients at 3 levels of clinical risk based on serum prostate specific antigen, Gleason sum and T stage. Time trends in test utilization were analyzed by linear regression. Contemporary rates were compared with those identified in a previous analysis of an earlier CaPSURE cohort. Demographic and clinical predictors of utilization were identified using generalized linear model analysis.


RESULTS
Since June 1997, the overall use of staging tests has decreased 63%, 25.9% and 11.4% in patients at low, intermediate and high risk, respectively. The most precipitous decrease was noted for bone scan but the use of cross-sectional imaging also decreased in all groups. Utilization rates were lower in 2001 than in any other year studied in CaPSURE.


CONCLUSIONS
The rates of testing decreased significantly in all risk groups. However, in the absence of established clinical practice guidelines many patients at low and intermediate risk continue to undergo unnecessary testing, while a growing number of those at high risk are proceeding to treatment without previous imaging.
Cooperberg
Matthew R
MR
Department of Urology, Program in Urologic Oncology, Urologic Outcomes Research Group, University of California-San Francisco/Mt. Zion Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California, USA.
Lubeck
Deborah P
DP
Grossfeld
Gary D
GD
Mehta
Shilpa S
SS
Carroll
Peter R
PR
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000639:trends*; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000473:pathology*; D014600:Utilization Review
D017430:Prostate-Specific Antigen