title: Updated trends in imaging use in men diagnosed with prostate cancer.
abstract: BACKGROUND
  Previous studies have found persistent overuse of imaging for clinical staging of men with low-risk prostate cancer. We aimed to determine imaging trends in three cohorts of men.
  
  
  METHODS
  We analyzed imaging trends of men with prostate cancer who were a part of Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) (1998-2006), were insured by Medicare (1998-2006), or privately insured (Ingenix database, 2002-2006). The rates of computed tomography (CT), magnetic resonance imaging (MRI) and bone scan (BS) were determined and time trends were analyzed by linear regression. For men in CaPSURE, demographic and clinical predictors of test use were explored using a multivariable regression model.
  
  
  RESULTS
  Since 1998, there was a significant downward trend in BS (16%) use in the CaPSURE cohort (N=5156). There were slight downward trends (2.4 and 1.7%, respectively) in the use of CT and MRI. Among 54 322 Medicare patients, BS, CT and MRI use increased by 2.1, 10.8 and 2.2% and among 16 161 privately insured patients, use increased by 7.9, 8.9 and 3.7%, respectively. In CaPSURE, the use of any imaging test was greater in men with higher-risk disease. In addition, type of insurance and treatment affected the use of imaging tests in this population.
  
  
  CONCLUSIONS
  There is widespread misuse of imaging tests in men with low-risk prostate cancer, particularly for CT. These findings highlight the need for examination of factors that drive decision making with respect to imaging in this setting.
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Porten
authors.affiliation: RAND Corporation, Santa Monica, CA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: A Y
authors.initials: AY
authors.lastname: Odisho
authors.affiliation: 1] Department of Urology, University of California, San Francisco, San Francisco, CA, USA [2] Department of Health Services, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Litwin
authors.affiliation: 1] Department of Urology, University of California, San Francisco, San Francisco, CA, USA [2] Department of Health Services, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Saigal
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: P R
authors.initials: PR
authors.lastname: Carroll
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Cooperberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003952:Diagnostic Imaging / Q000379:methods; D005006:Ethnicity; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016017:Odds Ratio; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy; D012042:Registries; D012307:Risk Factors