Are we still ‘choosing wisely’? Predictors of unnecessary staging imaging in US veteran patients with prostate cancer.

Abstract

e17147 Background: The American Society of Clinical Oncology’s Choosing Wisely (CW) initiative recommends against staging imaging for early-stage prostate cancer (PC) patients at low risk of developing metastasis. This study evaluates the proportion of Veterans diagnosed with early-stage PC who underwent potentially unnecessary staging imaging following the launch of the CW campaign and identifies factors associated with its use. Methods: We conducted a retrospective cohort study using data from the national Veterans Affairs Healthcare System and included all adult men diagnosed with T1c/T2a incident PC with a Gleason score of ≤6 and prostate-specific antigen level of <10 ng/ml from April 2012 through December 2022 (N=19,128). We assessed the proportion of patients who underwent at least one staging imaging procedure, including positron emission tomography, computerized tomography, or radionuclide bone scans within three months before or after their cancer diagnosis. Multivariable logistic regression was then used to identify significant predictors of staging imaging use. Results: Nearly one-quarter of patients (24.1%) underwent staging imaging procedures after the launch of the CW campaign. Significant predictors of staging imaging use included: Hispanic ethnicity (adjusted odds ratio (AOR)=1.43, 95% confidence interval (CI):1.19-1.72)), residence in east Northcentral (AOR=1.28, 95%CI:1.05-1.55), mid (AOR=2.32, 95%CI:1.89-2.86) or south Atlantic (AOR=1.48, 95%CI:1.24-1.77), or west south central (AOR=1.68, 95%CI:1.38-2.05), presence of at least one physical comorbidity (AOR were 1.26 and 1.41 for 1 vs 2 or more comorbidities, respectively, p<0.05) or mental health condition (AOR=1.21, 95%CI: 1.10-1.32), prostate-specific antigen level of 7.6-9.9 ng/ml (AOR=1.13, 95%CI: 1.00-1.29), T2a stage (AOR=1.19, 95%CI: 1.01-1.40), poor performance status (AOR=1.56, 95%CI: 1.36-1.77), and receipt of androgen deprivation therapy (AOR=1.40; 95%CI: 1.01-1.95). Fewer staging imaging procedures were observed in non-Hispanic Blacks (AOR=0.87, 95%CI: 0.78-0.97) and those residing in rural areas (AOR=0.89, 95%CI: 0.80-0.99). Conclusions: Our study highlighted several opportunities to enhance value-based staging imaging in Veterans diagnosed with early-stage PC.