Don’t perform PET, CT, and radionuclide bone scans in the staging of prostate cancer at low risk for metastasis in patients undergoing radical radiation therapy, except in a clinical research setting.

Type of practice

Imaging

Topic Area

Radiotherapy

Perform proper staging in patients with any form of neoplastic disease is absolutely necessary. However, CT, PET and bone scans are often used also in the initial staging of prostate cancer, in which the risk of metastases is minimal; evidence of literature do not support the use of these methods in patients at low risk of distant metastases (stage T1c / T2a; prostate specific antigen – PSA – less than 10 ng / ml and Gleason score less than or equal to 6).The use of such diagnostic methods inappropriately, can result in unjustified costs and unnecessary exposure to radiation, and delay the start of radiotherapy.

Sources

1. Makarov DV, Desai RA, Yu JB, et al. The population level prevalence and correlates of appropriate and inappropriate imaging to stage incident prostate cancer in the medicare population. J Urol. 2012 Jan; 187(1): 97-102.
2. National Comprehensive Cancer Network: NCCN clinical practice guidelines in oncology (NCCN Guidelines)- Prostate Cancer Version 4.2013.
3. Thompson I, Thrasher JB, Aus G, et AUA Prostate Cancer Clinical Guideline Update Panel. Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol. 2007 Jun; 177(6): 2106-31.

Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.