# Appropriateness of Imaging for Low-Risk Prostate Cancer—Real World Data from the Pennsylvania Urologic Regional Collaboration (PURC)

## TL;DR

This study examines how often unnecessary imaging is used for low-risk prostate cancer patients in Pennsylvania and finds that education can help reduce such practices.

## Contribution

The study provides real-world data on imaging use for low-risk prostate cancer and shows the impact of education on reducing unnecessary imaging.

## Key findings

- About 15% of low-risk prostate cancer patients underwent CT or bone scans, which guidelines discourage.
- Redundant imaging occurred in nearly one-third of low-risk patients.
- Iterative education among providers reduced the use of CT and bone scans.

## Abstract

Imaging for prostate cancer defines the extent of disease. Guidelines recommend against imaging low-risk prostate cancer patients with a computed tomography (CT) scan or bone scan due to the low probability of metastasis. We reviewed imaging performed for men diagnosed with low-risk prostate cancer across the Pennsylvania Urologic Regional Collaborative (PURC), a physician-led data sharing and quality improvement collaborative. The data of 10 practices were queried regarding the imaging performed in men diagnosed with prostate cancer from 2015 to 2022. The cohort included 13,122 patients with 3502 (27%) low-risk, 2364 (18%) favorable intermediate-risk, 3585 (27%) unfavorable intermediate-risk, and 3671 (28%) high-risk prostate cancer, based on the AUA guidelines. Amongst the low-risk patients, imaging utilization included pelvic MRI (59.7%), bone scan (17.8%), CT (16.0%), and PET-based imaging (0.5%). Redundant imaging occurred in 1022 patients (29.2%). There was variability among the PURC sites for imaging used in the low-risk patients, and iterative education reduced the need for CT and bone scans. Approximately 15% of low-risk patients had staging imaging performed using either a CT or bone scan, and redundant imaging occurred in almost one-third of men. Such data underscore the need for continued guideline-based education to optimize the stewardship of resources and reduce unnecessary costs to the healthcare system.