Background: Overuse of imaging in patients unlikely to have metastatic disease is costly and can lead to patient harm from unnecessary procedures. However, underuse of imaging leads to undiagnosed metastatic disease, resulting in aggressive treatments in incurable patients. The National Comprehensive Cancer Network (NCCN) recommends bone scans and computed tomography (CT) or magnetic resonance imaging (MRI) during initial work-up of select patients with intermediate or high risk CaP. We quantify the proportion of patients who received work-up discordant with NCCN guidelines. Methods: Patients in the Surveillance Epidemiology and End Results (SEER)-Medicare database diagnosed from 2004-2007 were included. We report bone scan and CT/MRI from date of diagnosis to the earlier of treatment or 6 months. Results: 65% of patients for whom bone scan is recommended received it, and 49% received recommended CT/MRI. Further, 43% of patients for whom bone scan is not recommended received it, and 38% received unnecessary CT/MRI. Age and race were significantly associated with discordance on multivariate models (Table). Underuse of recommended bone and CT/MRI scans decreased in more recent years, but overuse of unnecessary CT/MRI increased. There was significant regional variation. Conclusions: There is a high prevalence of both overuse and underuse of guideline-recommended imaging in CaP.

Also controlled for marital status, regional income, regional education level, urban/rural, first treatment, comorbidity.

*Referent.