Jennifer S. McDonald PhD, Presenter: Research Grant, General Electric Company

R. Jeffrey Karnes MD, Abstract Co-Author: Nothing to Disclose

Rickey Carter PhD, Abstract Co-Author: Nothing to Disclose

Paul R. Julsrud MD, Abstract Co-Author: Nothing to Disclose

John DeWitt Port MD, PhD, Abstract Co-Author: Nothing to Disclose

Claire E. Bender MD, Abstract Co-Author: Nothing to Disclose

The American College of Radiology (ACR) Appropriateness Criteria panel has recommended that post-treatment prostate cancer patients only receive imaging following suspicion of cancer recurrence, with radionuclide bone scan the recommended first modality. We examined whether local physicians followed these recommendations in a cohort of prostate cancer patients.

The [redacted for blinding purposes], a collection of the records of all medical centers in [redacted], was used to capture the complete medical history of local prostate cancer patients from 2000-2011. Clinical information, imaging exams performed, exam indication, and ordering physician specialty were retrieved by chart review. Only exams performed in relation to prostate cancer were included in the analysis. Treatment-specific PSA elevations, bone pain, or abnormal DRE were suggestive of cancer recurrence.

Out of the 670 patients that were included in the final analysis, 131 (20%) had suggested cancer recurrence. 129 patients (19%) received imaging following treatment. After excluding imaging performed in relation to retreatment or another cancer, 13 patients (10% of imaged patients) underwent imaging prior to or in the absence of cancer recurrence. A total of 90 patients (70% of imaged patients) underwent imaging following suspicion of cancer recurrence. Of these patients, 62 (68%) received a bone scan as their first imaging modality and 28 (31%) received another modality prior to a bone scan or did not receive a bone scan. Endorectal coil MRI, spinal X-ray, and transrectal ultrasound were performed most often prior to or in lieu of a bone scan. Patient age, Gleason score, and treatment type did not affect the likelihood of receiving a bone scan first. Radiation oncology, medical oncology, and internal medicine physicians were more likely to order a bone scan first, while urology and family practice physicians were less likely.

The majority of patients in this study did not receive imaging in the absence of prostate cancer recurrence. However, one third of patients with potential cancer recurrence did not receive a bone scan first as recommended.

Providers frequently order alternative imaging modalities for post-treatment prostate cancer patients with suspected cancer recurrence.

McDonald, J, Karnes, R, Carter, R, Julsrud, P, Port, J, Bender, C, Provider Adherence to the American College of Radiology’s Appropriateness Criteria for Post-treatment Follow-up of Prostate Cancer Patients.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018645.html