title: Inappropriate utilization of radiographic imaging in men with newly diagnosed prostate cancer in the United States.
abstract: BACKGROUND
  The use of radiographic imaging (bone scan and computerized tomography) is only recommended for men diagnosed with high-risk prostate cancer characteristics. The authors sought to characterize utilization patterns of imaging in men with newly diagnosed prostate cancer.
  
  
  METHODS
  The authors performed a population-based observational cohort study using the US Surveillance, Epidemiology, and End Results-Medicare linked data to identify 30,183 men diagnosed with prostate cancer during 2004 to 2005.
  
  
  RESULTS
  Thirty-four percent of men with low-risk and 48% with intermediate-risk prostate cancer underwent imaging, whereas only 60% of men with high-risk disease received imaging before treatment. Radiographic imaging utilization was greater for men who were older than 75 years (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.20-1.37; P < .001), were black (OR, 1.11; 95% CI, 1.01-1.21; P = .030), resided in wealthier areas (OR, 1.19; 95% CI, 1.08-1.32 for median income >$60,000 vs <$35,000; P < .001), lived in rural regions (OR, 1.23; 95% CI, 1.12-1.36; P < .001), or underwent standard radiation therapies (OR, 1.71; 95% CI, 1.60-1.84; P < .001). Imaging utilization was less for men living in areas with greater high school education (OR, 0.83; 95% CI, 0.75-0.91 between highest and lowest graduation rates; P < .001) or opting for active surveillance (OR, 0.17; 95% CI, 0.15-0.19 vs radical prostatectomy; P < .001). The estimated cost of unnecessary imaging over this 2-year period exceeded $3.6 million.
  
  
  CONCLUSIONS
  In the United States, there is widespread overutilization of imaging for low-risk and intermediate-risk prostate cancer, whereas a worrisome number of men with high-risk disease did not receive appropriate imaging studies to exclude metastases before therapy.
authors.affiliation: Section of Urology, University of Chicago Medical Center, Chicago, Illinois, USA.
authors.forename: Sandip M
authors.initials: SM
authors.lastname: Prasad
authors.forename: Xiangmei
authors.initials: X
authors.lastname: Gu
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D003952:Diagnostic Imaging / Q000191:economics / Q000706:statistics & numerical data*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D011859:Radiography; D012307:Risk Factors; D018426:SEER Program; D014481:United States / Q000453:epidemiology