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Abstract：
The American Urological Association\'s (AUA) and National Comprehensive Cancer Network\'s (NCCN) provide highly recognized guidelines for staging prostate cancer (CaP). However, both are vague as to specific type of cross-sectional imaging (CT vs. MRI) and extent (abdominal vs. pelvis), thereby raising concern for overlapping imaging. We investigated if current AUA and NCCN CaP staging guidelines can become more specific yet maintain sufficient staging.
We identified 493 patients diagnosed with CaP between 2011 and 2017 and focused analysis on those with AUA and NCCN Intermediate risk (IR) and High risk (HR) groups. Type of staging imaging was recorded and frequency of overlapping (CT + MRI) and abdominal imaging determined. Significance of radiologist findings, for both overlapping and abdominal imaging, were classified as nonurologic, nonsignificant urologic, and CaP significant.
Among IR and HR AUA and NCCN risk groups, 82 (35.7%) and 95 (37.3%) patients, respectively, experienced overlapping imaging, of which only 7 patients in AUA and 9 patients in NCCN risk groups had an abnormal CT with normal MRI. However, only 3 of these CTs had CaP significant findings, of which 2 identified bone metastases, which were subsequently detected on bone scan. In regard to the extent of imaging, a total of 157 (68.2%) AUA and 178 (69.8%) NCCN IR and HR patients received abdominal scans, of which only 46 (20.0%) and 49 (19.2%) were abnormal among AUA and NCCN risk groups, respectively. Among these abnormal abdominal scans, only 10 showed CaP significant findings, of which half were suspected bone metastases, and confirmed on recommended bone scan.
Due to nonspecific staging guidelines in IR and HR CaP regarding type and extent of cross-sectional imaging, patients are frequently receiving imaging of overlapping locations. Based on low occurrences of unique CaP significant findings on CT and abdominal imaging, our exploratory analysis suggests that narrowing cross-sectional imaging recommendations to pelvic MRI may reduce imaging overlap while maintaining sufficient staging.
We identified 493 patients diagnosed with CaP between 2011 and 2017 and focused analysis on those with AUA and NCCN Intermediate risk (IR) and High risk (HR) groups. Type of staging imaging was recorded and frequency of overlapping (CT + MRI) and abdominal imaging determined. Significance of radiologist findings, for both overlapping and abdominal imaging, were classified as nonurologic, nonsignificant urologic, and CaP significant.
Among IR and HR AUA and NCCN risk groups, 82 (35.7%) and 95 (37.3%) patients, respectively, experienced overlapping imaging, of which only 7 patients in AUA and 9 patients in NCCN risk groups had an abnormal CT with normal MRI. However, only 3 of these CTs had CaP significant findings, of which 2 identified bone metastases, which were subsequently detected on bone scan. In regard to the extent of imaging, a total of 157 (68.2%) AUA and 178 (69.8%) NCCN IR and HR patients received abdominal scans, of which only 46 (20.0%) and 49 (19.2%) were abnormal among AUA and NCCN risk groups, respectively. Among these abnormal abdominal scans, only 10 showed CaP significant findings, of which half were suspected bone metastases, and confirmed on recommended bone scan.
Due to nonspecific staging guidelines in IR and HR CaP regarding type and extent of cross-sectional imaging, patients are frequently receiving imaging of overlapping locations. Based on low occurrences of unique CaP significant findings on CT and abdominal imaging, our exploratory analysis suggests that narrowing cross-sectional imaging recommendations to pelvic MRI may reduce imaging overlap while maintaining sufficient staging.
摘要：
美国泌尿外科协会（AUA）和国家综合癌症网络（NCCN）为前列腺癌（CaP）的分期提供了高度认可的指南。然而,对于特定类型的横截面成像(CT与MRI）和范围（腹部与骨盆),从而引起对重叠成像的关注。我们调查了当前的AUA和NCCNCaP分期指南是否可以变得更具体但仍保持足够的分期。
我们确定了2011年至2017年间诊断为CaP的493例患者，并重点分析了AUA和NCCN中等风险（IR）和高风险（HR）组。记录分期成像类型并确定重叠频率(CT+MRI)和腹部成像。放射科医生发现的意义，对于重叠和腹部成像，被归类为非泌尿科，非显著泌尿外科，和CaP显著。
在IR和HRAUA和NCCN风险组中，82例（35.7%）和95例（37.3%）患者，分别,有经验的重叠成像，其中AUA中只有7例患者和NCCN风险组中的9例患者的CT异常，MRI正常。然而,这些CT中只有3个有明显的CaP发现,其中2人确定了骨转移，随后在骨扫描中检测到。关于成像的程度，共157例（68.2%）AUA和178例（69.8%）NCCNIR和HR患者接受了腹部扫描，其中AUA和NCCN风险组中只有46例（20.0%）和49例（19.2%）异常，分别。在这些异常的腹部扫描中，只有10个显示了CaP的重要发现，其中一半怀疑是骨转移，并在推荐的骨扫描中证实。
由于关于横断面成像的类型和程度的IR和HRCaP的非特异性分期指南，患者经常接受重叠位置的成像。基于CT和腹部影像学上独特的CaP显著发现的低发生率，我们的探索性分析提示,将骨盆MRI的横断面影像建议缩小范围可能会减少影像重叠,同时保持足够的分期.
我们确定了2011年至2017年间诊断为CaP的493例患者，并重点分析了AUA和NCCN中等风险（IR）和高风险（HR）组。记录分期成像类型并确定重叠频率(CT+MRI)和腹部成像。放射科医生发现的意义，对于重叠和腹部成像，被归类为非泌尿科，非显著泌尿外科，和CaP显著。
在IR和HRAUA和NCCN风险组中，82例（35.7%）和95例（37.3%）患者，分别,有经验的重叠成像，其中AUA中只有7例患者和NCCN风险组中的9例患者的CT异常，MRI正常。然而,这些CT中只有3个有明显的CaP发现,其中2人确定了骨转移，随后在骨扫描中检测到。关于成像的程度，共157例（68.2%）AUA和178例（69.8%）NCCNIR和HR患者接受了腹部扫描，其中AUA和NCCN风险组中只有46例（20.0%）和49例（19.2%）异常，分别。在这些异常的腹部扫描中，只有10个显示了CaP的重要发现，其中一半怀疑是骨转移，并在推荐的骨扫描中证实。
由于关于横断面成像的类型和程度的IR和HRCaP的非特异性分期指南，患者经常接受重叠位置的成像。基于CT和腹部影像学上独特的CaP显著发现的低发生率，我们的探索性分析提示,将骨盆MRI的横断面影像建议缩小范围可能会减少影像重叠,同时保持足够的分期.
