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Characterising potential bone scan overuse amongst men treated with radical prostatectomy
Author(s) -
Kirk Peter S.,
Borza Tudor,
Caram Megan E.V.,
Shumway Dean A.,
Makarov Danil V.,
Burns Jennifer A.,
Shelton Jeremy B.,
Leppert John T.,
Chapman Christina,
Chang Michael,
Hollenbeck Brent K.,
Skolarus Ted A.
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14551
Subject(s) - medicine , prostate cancer , prostatectomy , confidence interval , logistic regression , odds ratio , androgen deprivation therapy , urology , prostate specific antigen , cancer
Objectives To characterise bone scan use, and potential overuse, after radical prostatectomy (RP) using data from a large, national integrated delivery system. Overuse of imaging is well documented in the setting of newly diagnosed prostate cancer, but whether overuse persists after RP remains unknown. Patients and methods We identified 12 269 patients with prostate cancer treated with RP between 2005 and 2008 using the Veterans Administration Central Cancer Registry. We used administrative and laboratory data to examine rates of bone scan use, including preceding prostate‐specific antigen ( PSA ) levels, and receipt of adjuvant or salvage therapy. We then performed multivariable logistic regression to identify factors associated with post‐RP bone scan use. Results At a median follow‐up of 6.8 years, one in five men (22%) underwent a post‐RP bone scan at a median PSA level of 0.2 ng/ mL . Half of bone scans (48%) were obtained in men who did not receive further treatment with androgen‐deprivation or radiation therapy. After adjustment, post‐RP bone scan was associated with a prior bone scan (adjusted odds ratio [ aOR ] 1.55, 95% confidence interval [ CI ] 1.32–1.84), positive surgical margin ( aOR 1.68, 95% CI 1.40–2.01), preoperative PSA level ( aOR 1.02, 95% CI 1.01–1.03), as well as Hispanic ethnicity, Black race, and increasing D'Amico risk category, but not with age or comorbidity. Conclusion We found a substantial rate of bone scan utilisation after RP. The majority were performed for PSA levels of <1 ng/ mL where the likelihood of a positive test is low. More judicious use of imaging appears warranted in the post‐RP setting.