COMMENTARY

Swedes Show That We Can Improve Imaging in Prostate Cancer

Gerald Chodak, MD

Disclosures

August 19, 2013

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Giving Physicians Feedback on Imaging Use

Hello. I am Dr. Gerald Chodak for Medscape. This week's topic focuses on ways to improve the quality of care of men diagnosed with prostate cancer. In the Journal of the National Cancer Institute, Makarov and coworkers[1] reported a retrospective analysis of more than 100,000 men from Sweden. Starting in 1998, the Swedish government implemented a program to let doctors know regionally and in their hospitals who was ordering tests and imaging studies inappropriately. They made a conscious effort to define men with low-risk prostate cancer who did not need imaging studies as part of their workup. The men were followed, and each year at meetings and through other ways of disseminating information, doctors were updated on how the men were doing.

The results were interesting. They showed that over time there was a reduction from 43% to 3% in the number of men with low-risk disease (a Gleason score of 6 or lower, prostate-specific antigen level < 10 ng/mL, and clinical T1 disease) who received an inappropriate scan. This implementation had a positive effect in lowering the misuse of tests. Unfortunately, there was also about a 15% drop in the proper use of scanning for men with high-risk disease, and it is unclear why that occurred.

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