Category: Epidemiology, Health Policy, Socioeconomics & Outcomes
Introduction & Objective :
The indications for performing bone scan (BS) in initial staging of newly diagnosed prostate cancer are well established across all risk categories and grade groupings, with proven very low yield in D’Amico low and intermediate risk groups with primary pattern 3 disease.We examined nationwide trends in bone scan usage in patients undergoing surgery for prostate cancer by analysing the British Association of Urological Surgeons (BAUS) Radical Prostatectomy (RP) database.
We analysed BAUS RP database between 2007 – 2016. Patients who had BS were categorised into D’Amico low risk (LR), intermediate risk (IR) and high risk (HR) categories. The IR group was further sub-classified into those with primary pattern 3 (IR3) or 4 (IR4). Indications for BS in this cohort were compared against present guidelines to determine adherence and trends.
A total of 39382 patients were on the database during this period. Data entry, completeness and quality improved significantly from 2011 onwards (from 55% in 2011 to 90% in 2016). Gradual drop in proportion of LR who had BS before RP was noted over the years in UK. It constituted <1% of patients who had BS in 2016. This is paralleled by a consistent increase in proportion of HR patients and it stood at 61.55% in 2016. There was no significant change in both IR3 & IR4 groups over the years. Results are summarised in table below.
BS are still over utilised across UK in low and intermediate risk group patients with primary pattern 3 and potentially underutilised in HR group patients. This study represents a unique opportunity to rationalise BS usage in the UK based on national audit data.
We would recommend performing routine BS only in patients belonging to IR4 and HR groups, in line with latest evidence.
Gokul KandaSwamy– Consultant Urological Surgeon, Department of Urology, Morriston hospital, ABM University Health Board, Swansea, United Kingdom, Swansea, Wales, United Kingdom
Krishna Narahari– Cardiff, Wales, United Kingdom
Howard Kynaston– Cardiff, Wales, United Kingdom
Consultant Urological Surgeon
Department of Urology, Morriston hospital, ABM University Health Board, Swansea, United Kingdom
Swansea, Wales, United Kingdom