Prior to the PSA era of prostate cancer detection, a large proportion of the patients diagnosed were found to have already progressed to an advanced stage of the disease. These patients frequently required imaging to determine which patients would benefit from localized treatment, and CT and bone scan became very common staging examinations in this situation.
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The PSA test has allowed for a stage migration towards more localized disease and, as such, most patients no longer require staging imaging prior to localized treatment. Multiple professional societies have issued guidelines on the proper use of imaging in prostate cancer since the mid-1990s, but a significant number of patients continue to undergo inappropriate imaging (1).
This paper is a comprehensive review of the different recommendations and guidelines put together by the following societies: National Comprehensive Cancer Network, American Urologic Association, European Association of Urology, National Institute for Health and Care Excellence, American College of Radiology, and others. In this review, individual imaging recommendations are addressed, and overall suggestions are made about the specific need for different imaging modalities for evaluating and staging prostate cancer. It is our hope that as physicians further understand the utility of different imaging tests, they will reduce unnecessary examinations and optimize utilization of resources by conserving these tests for patients at higher risk of more advanced disease.
1. Makarov, Danil V et al. "The population level prevalence and correlates of appropriate and inappropriate imaging to stage incident prostate cancer in the medicare population." The Journal of Urology 187.1 (2012): 97-102.
Daniel Wollin, MD
NYU Langone Medical Center.