The population level prevalence and correlates of appropriate and inappropriate imaging to stage incident prostate cancer in the medicare population

Danil V. Makarov, Rani A. Desai, James B. Yu, Richa Sharma, Nitya E. Abraham, Peter C. Albertsen, David F. Penson, Cary P. Gross

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Purpose: According to guidelines most men with incident prostate cancer do not require staging imaging. We determined the population level prevalence and correlates of appropriate and inappropriate imaging in this cohort. Materials and Methods: We performed a cross-sectional study of men 66 to 85 years old who were diagnosed with prostate cancer in 2004 and 2005 from the SEER (Surveillance, Epidemiology and End Results)-Medicare database. Low risk (no prostate specific antigen greater than 10 ng/ml, Gleason score greater than 7 or clinical stage greater than T2) and high risk (1 or more of those features) groups were formed. Inappropriate imaging was defined as any imaging for men at low risk and appropriate imaging was defined as bone scan for men at high risk as well as pelvic imaging as appropriate. Logistic regression modeled imaging in each group. Results: Of 18,491 men at low risk 45% received inappropriate imaging while only 66% of 10,562 at high risk received appropriate imaging. For patients at low risk inappropriate imaging was associated with increasing clinical stage (T2 vs T1 OR 1.35, 95% CI 1.271.44), higher Gleason score (7 vs less than 7 OR 1.80, 95% CI 1.691.92), increasing age and comorbidity as well as decreasing education. Appropriate imaging for men at high risk was associated with lower stage (T4, T3 and T2 vs T1 OR 0.63, 95% CI 0.480.82, OR 0.67, 95% CI 0.600.80 and OR 0.87, 95% CI 0.800.86) and with higher Gleason score (greater than 8 and 7 vs less than 7 OR 2.18, 95% CI 1.922.48 and 1.51, 95% CI 1.351.70, respectively) as well as with younger age, white race, higher income, lower stage and more comorbidity. Conclusions: We found poor adherence to imaging guidelines for men with incident prostate cancer. Understanding the patterns by which clinicians use imaging for prostate cancer should guide educational efforts as well as research to suggest evidence-based guideline improvements.

Original languageEnglish (US)
Pages (from-to)97-102
Number of pages6
JournalJournal of Urology
Volume187
Issue number1
DOIs
StatePublished - Jan 2012
Externally publishedYes

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Medicare
Prostatic Neoplasms
Population
Neoplasm Grading
Guidelines
Comorbidity
Prostate-Specific Antigen
Epidemiology
Cross-Sectional Studies
Logistic Models
Databases
Education
Bone and Bones
Research

Keywords

  • diagnostic imaging
  • Medicare
  • prostate
  • prostatic neoplasms
  • SEER program

ASJC Scopus subject areas

  • Urology

Cite this

The population level prevalence and correlates of appropriate and inappropriate imaging to stage incident prostate cancer in the medicare population. / Makarov, Danil V.; Desai, Rani A.; Yu, James B.; Sharma, Richa; Abraham, Nitya E.; Albertsen, Peter C.; Penson, David F.; Gross, Cary P.

In: Journal of Urology, Vol. 187, No. 1, 01.2012, p. 97-102.

Research output: Contribution to journalArticle

Makarov, Danil V. ; Desai, Rani A. ; Yu, James B. ; Sharma, Richa ; Abraham, Nitya E. ; Albertsen, Peter C. ; Penson, David F. ; Gross, Cary P. / The population level prevalence and correlates of appropriate and inappropriate imaging to stage incident prostate cancer in the medicare population. In: Journal of Urology. 2012 ; Vol. 187, No. 1. pp. 97-102.
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AU - Makarov, Danil V.

AU - Desai, Rani A.

AU - Yu, James B.

AU - Sharma, Richa

AU - Abraham, Nitya E.

AU - Albertsen, Peter C.

AU - Penson, David F.

AU - Gross, Cary P.

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N2 - Purpose: According to guidelines most men with incident prostate cancer do not require staging imaging. We determined the population level prevalence and correlates of appropriate and inappropriate imaging in this cohort. Materials and Methods: We performed a cross-sectional study of men 66 to 85 years old who were diagnosed with prostate cancer in 2004 and 2005 from the SEER (Surveillance, Epidemiology and End Results)-Medicare database. Low risk (no prostate specific antigen greater than 10 ng/ml, Gleason score greater than 7 or clinical stage greater than T2) and high risk (1 or more of those features) groups were formed. Inappropriate imaging was defined as any imaging for men at low risk and appropriate imaging was defined as bone scan for men at high risk as well as pelvic imaging as appropriate. Logistic regression modeled imaging in each group. Results: Of 18,491 men at low risk 45% received inappropriate imaging while only 66% of 10,562 at high risk received appropriate imaging. For patients at low risk inappropriate imaging was associated with increasing clinical stage (T2 vs T1 OR 1.35, 95% CI 1.271.44), higher Gleason score (7 vs less than 7 OR 1.80, 95% CI 1.691.92), increasing age and comorbidity as well as decreasing education. Appropriate imaging for men at high risk was associated with lower stage (T4, T3 and T2 vs T1 OR 0.63, 95% CI 0.480.82, OR 0.67, 95% CI 0.600.80 and OR 0.87, 95% CI 0.800.86) and with higher Gleason score (greater than 8 and 7 vs less than 7 OR 2.18, 95% CI 1.922.48 and 1.51, 95% CI 1.351.70, respectively) as well as with younger age, white race, higher income, lower stage and more comorbidity. Conclusions: We found poor adherence to imaging guidelines for men with incident prostate cancer. Understanding the patterns by which clinicians use imaging for prostate cancer should guide educational efforts as well as research to suggest evidence-based guideline improvements.

AB - Purpose: According to guidelines most men with incident prostate cancer do not require staging imaging. We determined the population level prevalence and correlates of appropriate and inappropriate imaging in this cohort. Materials and Methods: We performed a cross-sectional study of men 66 to 85 years old who were diagnosed with prostate cancer in 2004 and 2005 from the SEER (Surveillance, Epidemiology and End Results)-Medicare database. Low risk (no prostate specific antigen greater than 10 ng/ml, Gleason score greater than 7 or clinical stage greater than T2) and high risk (1 or more of those features) groups were formed. Inappropriate imaging was defined as any imaging for men at low risk and appropriate imaging was defined as bone scan for men at high risk as well as pelvic imaging as appropriate. Logistic regression modeled imaging in each group. Results: Of 18,491 men at low risk 45% received inappropriate imaging while only 66% of 10,562 at high risk received appropriate imaging. For patients at low risk inappropriate imaging was associated with increasing clinical stage (T2 vs T1 OR 1.35, 95% CI 1.271.44), higher Gleason score (7 vs less than 7 OR 1.80, 95% CI 1.691.92), increasing age and comorbidity as well as decreasing education. Appropriate imaging for men at high risk was associated with lower stage (T4, T3 and T2 vs T1 OR 0.63, 95% CI 0.480.82, OR 0.67, 95% CI 0.600.80 and OR 0.87, 95% CI 0.800.86) and with higher Gleason score (greater than 8 and 7 vs less than 7 OR 2.18, 95% CI 1.922.48 and 1.51, 95% CI 1.351.70, respectively) as well as with younger age, white race, higher income, lower stage and more comorbidity. Conclusions: We found poor adherence to imaging guidelines for men with incident prostate cancer. Understanding the patterns by which clinicians use imaging for prostate cancer should guide educational efforts as well as research to suggest evidence-based guideline improvements.

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