Swedish campaign cuts inappropriate prostate cancer imaging

An effort in Sweden aimed at reducing inappropriate use of imaging to stage incident prostate cancer appears to be succeeding, and similar programs may help cut inappropriate imaging in the United States, researchers say.

Imaging use decreased over time, particularly in low-risk men, among whom the imaging rate decreased from 45% to 3%, study authors from U.S. and Swedish institutions reported online in the Journal of the National Cancer Institute (July 13, 2013).

The effort of Sweden’s National Prostate Cancer Register (NPCR), begun in 2000, disseminates utilization data and the latest imaging guidelines to urologists in that country as a method to decrease national rates of inappropriate prostate cancer imaging. To determine the effects of this program, researchers performed a retrospective cohort study among nearly 100,000 men diagnosed with prostate cancer from the NPCR from 1998 to 2009. Imaging use over time stratified by clinical risk category (low, intermediate, high) and geographic region was analyzed.

A total of 36% of men underwent imaging within 6 months of prostate cancer diagnosis. Imaging use decreased over time, with men in the low-risk category showing a decrease in the imaging rate from 45% to 3% (p<.001). The rate also decreased among men in the high-risk category, from 63% to 47% (p<.001). Despite substantial regional variation, all regions experienced clinically and statistically significant decreases (p<.001) in prostate cancer imaging, reported first author Danil Makarov, MD, of NYU Langone Medical Center, New York.

“Although appropriate imaging suffered to a small extent, these national-level results are truly remarkable because many previous guidelines and policy efforts have failed to reduce inappropriate prostate cancer imaging in the United States,” Dr. Makarov and colleagues wrote.

Earlier this year and in 2012, the AUA and American Society of Clinical Oncology emphasized the need to reduce inappropriate imaging for low-risk prostate cancer in the Choosing Wisely campaign, a multidisciplinary effort to reduce unnecessary medical testing, decrease overuse of health care resources, and improve quality of care. Among its Choosing Wisely recommendations, the AUA said a routine bone scan is unnecessary in men with low-risk prostate cancer, while ASCO recommended against advanced imaging in newly diagnosed low-grade prostate cancer (Gleason score ≤6) in men with a PSA <10.0 ng/mL.

"By tackling the overuse of treatments and tests for some of the most common cancers, we hope to achieve substantial improvements in the quality of cancer care in the U.S.,” said Lowell E. Schnipper, MD, of ASCO’s Cost of Care Task Force.

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