THE "NEW" PROSTATE CANCER INFOLINK

Here in the USA, about half the patients diagnosed with low-risk prostate cancer are still (apparently) being sent for “guideline-discordant” (i.e., unnecessary) bone scans and CT scans, and a new research paper has clearly shown that it isn’t patient demand that is causing this to happen.

Between September 2014 and July 2015, Makarov et al. carried out a set of 22 interviews with prostate cancer patients and 17 interviews with physicians who cared for them at three Veterans Administration medical centers that represented a spectrum of inappropriate imaging rates.

Their research clearly showed the following with regard to the patients:

• Patients had much less interest in prostate cancer staging as compared to disease treatment.
• Many patients couldn’t even remember whether they’d had imaging tests at all.
• The patients tended to texpress and exhibit trust in their doctors to make decisions about appropriate tests.
• Some patients expressed mild concerns about radiation exposure, but their anxiety about cancer outcomes outweighed these concerns.

The results for the doctors were very different:

• Most physicians self-reported that they know and trust imaging guidelines, but …
• Some physicians still tended to follow their own intuition, because of clinical suspicion or years of experience.
• Physicians reported that a spectrum of other issues also affected their decisions, including
  • Medico-legal concerns
  • Fear of missing associated diagnoses
  • Influence from colleagues who image frequently
  • Influence of rates of imaging at the facility where they practice

It appears that we have a ways to go before we are going to be able to persuade the average urologist that most low-risk patients really don’t need a bone scan and a CT scan! And of course there are very real exceptions to every rule.

Filed under: Diagnosis, Management, Risk | Tagged: appropriate, bone, CT, inappropriate, scan, why |