title: Clinical predictors and recommendations for staging computed tomography scan among men with prostate cancer.
abstract: OBJECTIVE
  To identify clinical variables associated with a positive computed tomography (CT) scan and estimate the performance of imaging recommendations in patients from a diverse sample of urology practices.
  
  
  METHODS
  This study comprised 2380 men with newly diagnosed prostate cancer seen at 28 practices in the Michigan Urological Surgery Improvement Collaborative from March 2012 through September 2013. Data included age, prostate-specific antigen (PSA) level, Gleason score (GS), clinical T stage, total number of positive biopsy cores, whether or not the patient received a staging abdominal and/or pelvic CT scan, and CT scan result. We fit a multivariate logistic regression model to identify clinical variables associated with metastases detected by CT scan. We estimated the sensitivity and specificity of existing imaging recommendations.
  
  
  RESULTS
  Among 643 men (27.4%) who underwent a staging CT scan, 62 men (9.6%) had a positive study. In the multivariate analysis, PSA, GS, and clinical T stage were independently associated with the occurrence of a positive CT scan (all P values <.05). The American Urological Association's Best Practice Statements' recommendations for imaging when PSA level >20 ng/mL or GS ≥ 8 or locally advanced cancer had a sensitivity of 87.3% and specificity of 82.6%. Compared with current practice, implementing this recommendation in the Michigan Urological Surgery Improvement Collaborative population was estimated to result in approximately 0.5% of positive study results being missed, and 26.1% of fewer study results overall.
  
  
  CONCLUSIONS
  Successful implementation of CT imaging criterion of PSA level >20, GS ≥ 8, or clinical stage ≥ T3 would ensure that CT scans are performed for almost all men who would have positive study results while reducing the number of negative study results.
authors.affiliation: Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI.
authors.forename: Rachel
authors.initials: R
authors.lastname: Risko
authors.affiliation: Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI.
authors.forename: Selin
authors.initials: S
authors.lastname: Merdan
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Womble
authors.affiliation: Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI.
authors.forename: Christine
authors.initials: C
authors.lastname: Barnett
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI.
authors.forename: Zaojun
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Linsell
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI.
authors.forename: James E
authors.initials: JE
authors.lastname: Montie
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.affiliation: Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI; Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: btdenton@umich.edu.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Denton
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001707:Biopsy, Needle; D015331:Cohort Studies; D006801:Humans; D007150:Immunohistochemistry; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D012042:Registries; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014481:United States
chemical_list: D017430:Prostate-Specific Antigen