NEW YORK — Inappropriate imaging to stage low-risk prostate cancer is considered low-value care. A new VA study sought to determine the effectiveness of a theory-based intervention, Prostate Cancer Imaging Stewardship (PCIS), to promote guideline-concordant imaging.
The stepped-wedge, cluster-randomized trial, PCIS, was conducted between March 2018 and March 2021 at 10 VAMCs initially selected for prostate cancer volume, geographic diversity and willingness to participate.
The study was led by researchers from VA New York Harbor Healthcare System and NYU Langone Health, both in New York. Participating were VAMCs in Madison, WI; Syracuse, NY; Pittsburgh; Minneapolis; Seattle; West Haven, CT; Palo Alto, CA; Salt Lake City; Los Angeles; and Portland, OR.
Published in the Journal of the National Cancer Institute, the study involved Intervention initiation at sites which were randomized in 3-month intervals. The researchers enrolled 61 urology providers who treat prostate cancer at participating sites.
Outcomes were assessed among 2,302 adult patients with incident prostate cancer.
The authors explained that PCIS combines three evidence-based provider-focused behavior change strategies:
- Clinical Reminder Order Check, triggered when a provider attempted to order imaging for a patient with PSA < 20ng/mL;
- VAMC-level academic detailing at initiation and every three months thereafter; and
- Audit and Feedback for providers to improve their imaging performance.
Defined as the main outcome was guideline-discordant nuclear medicine bone scan (NMBS) imaging for low-risk prostate cancer patients.
The study found that NMBS imaging would be consistent with National Comprehensive Cancer Network guidelines in 878 patients (38%) and inconsistent in 1,424 patients (62%).
The researchers determined that, among patients not requiring NMBS, 141/690 (20.4%) received guideline-discordant imaging (i.e., NMBS ordered) during control compared with 109/734 (14.9%) during Intervention (OR = 0.54, p = 0.04).
Among patients requiring a NMBS, 29/425 (6.8%) did not receive one (i.e., guideline-discordant imaging) during control compared with 25/453 (5.5%) during the Intervention (OR = 1.36, p = 0.36).
“PCIS significantly reduced low-value, guideline-discordant NMBS imaging among low-risk prostate cancer patients without negatively affecting necessary imaging for high-risk patients,” the authors concluded.
- Makarov DV, Thomas JK, Ciprut S, Rivera AJ, et. Al. Prostate Cancer Imaging Stewardship: a multi-modal, physician-centered intervention for guideline-concordant imaging. J Natl Cancer Inst. 2025 Aug 11:djaf210. doi: 10.1093/jnci/djaf210. Epub ahead of print. PMID: 40796156.
