Use of Evidence-Based Prostate Cancer Imaging in an Integrated Health-Care System

Key Points

  • Nonindicated imaging in men with low-risk prostate cancer decreased in frequency between 2004 and 2011.
  • Use of imaging in men with high-risk prostate cancer declined to a lesser degree over this period.

In a study reported in the Journal of Oncology Practice, Salloum et al found that use of nonindicated imaging for diagnostic staging of low-risk prostate cancer in a nonprofit integrated health-care system remained common but has decreased in frequency.

As noted by the authors: “The overuse of imaging, particularly for staging of low-risk prostate cancer, is well documented and widespread. The existing literature, which focuses on the elderly in fee-for-service settings, points to financial incentives as a driver of overuse and may not identify factors relevant to policy solutions within integrated health care systems, where physicians are salaried.”

Study Details

The study analyzed imaging rates among men with incident prostate cancer diagnosed between 2004 and 2011 in the Colorado (Denver) and Northwest (Portland) regions of Kaiser Permanente. Of the 3,799 men meeting inclusion criteria, 1,398 were classified as having low-risk disease (Gleason score < 7), for which imaging is discouraged, and 2,401 were classified as having high-risk disease (Gleason score ≥ 7).

Use of Imaging

Overall, 35% of men with low-risk disease received nonindicated imaging, and 42% of high-risk men did not receive indicated imaging. Compared with 2004, imaging was less commonly used in both risk groups in subsequent years; for example, the imaging rate decreased from 64.0% to 54.3% in 2011 in high-risk men and from 55.9% to 27.0% in 2011 in low-risk men.

Indicated imaging in high-risk men was significantly more likely for those aged 66 to 74 years (odds ratio [OR] = 1.65) and ≥ 75 years (OR = 1.58) vs those aged 50 to 65 years. Imaging was more likely in both high-risk (OR = 1.37) and low-risk men (OR = 1.48) with at least one comorbidity. Imaging was also more likely in high-risk men with clinical stage ≥ T2 (OR = 1.45) and was less likely in low-risk men with a higher median household income (OR = 0.69).

The investigators concluded: “Non-indicated imaging for diagnostic staging of patients with low-risk prostate cancer was common but has decreased over the past decade. These findings suggest that factors other than financial incentives may be driving overuse of imaging.”

Ramzi G. Salloum, PhD, of the University of Florida College of Medicine, Gainesville, is the corresponding author of the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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