Did you know that radiographic imaging studies (CT scans, bone scans and MRI) will detect disease outside of the prostate gland less than 1% of the time in men who are diagnosed with either “low” or “intermediate” risk prostate cancer? (i.e. Gleason scores </=7, clinical T1-T2 tumors, PSA </=20 ng/ml)
Based on a recently reported study of over 30,000 men with prostate cancer, radiographic staging studies are being inappropriately used in 36% of men with low-risk disease and 49% of the time in those with intermediate-risk disease.
These findings raise obvious potential health concerns for many patients (i.e. exposure to ionizing radiation from CT scans and bone scans increases one’s risk of developing cancer), and should be recognized as an unnecessary (and significant) expense to our patients and the already overburdened healthcare system. “This is a perfect example of how we are wasting money on inappropriate tests and the denying other people of appropriate care.” (Dr.Mack Roach, University of California, San Franscisco, Professor and Chair of Radiation Oncology and Professor of Urology)
Widely accepted oncology guidelines (i.e. National Comprehensive Cancer Network) only recommends radiographic staging on all patients with high-risk cancers (i.e. Gleason scores 8-10, clinical T3-T4 tumors, PSA >20 ng/ml), as these individuals have a significantly greater risk of extraprostatic cancer at presentation. Radiographic staging is employed in these patients to help direct therapeutic management decisions. One of the most concerning findings of this study was that 39% of men with high-risk prostate cancer did not receive any radiographic staging.
To learn more about pretreatment radiographic staging studies in prostate cancer, the American College of Radiology has established appropriateness guidelines that are based on a variety of diagnostic variables (i.e. Gleason score, PSA, clinical stage, number of positive biopsies).
I often provide my patients with references from the National Comprehensive Cancer Network (NCCN). The advisors for the NCCN comprise experts from numerous academic institutions. These experts typically update their guidelines at least once a year. I find their prostate cancer patient guide to be very user-friendly. It includes information on diagnostic tests, risk categories, management options and side effects. The flowcharts (pages 44-52) are great visual aids for better understanding staging, treatment and follow-up recommendations.