Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer

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A bone scan is generally not required for staging prostate cancer in men with a low (or very low) risk of recurrence and receiving primary therapy. This measure is written as a negative measure so that the performance goal is 100%, consistent with the other measures for this condition.

Routine use of a bone scan is not required for staging asymptomatic men with clinically localized prostate cancer when their PSA level is equal to or less than 20.0 ng/mL. (AUA, 2013)

For symptomatic patients and/or those with a life expectancy of greater than 5 years, a bone scan is appropriate for patients with any of the following: 1) T1 disease with PSA over 20 ng/mL or T2 disease with PSA over 10 ng/mL; 2) a Gleason score of 8 or higher; 3) T3 to T4 tumors; or 4) symptomatic disease. (NCCN, 2015) (Category 2A)

Higher score indicates better quality

American Urological Association Education and Research, Inc. PSA testing for the pretreatment staging and posttreatment management of prostate cancer: 2013 Revision of 2009 Best Practice Statement. Linthicum, MD: American Urological Association Education and Research, Inc. 2013. Available at: https://www.auanet.org/common/pdf/education/clinical-guidance/Prostate-Specific-Antigen.pdf

National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 1.2015. Available at www.nccn.org

Risk Strata Definitions: Very Low, Low, Intermediate, High, or Very High- 
Very Low Risk - PSA < 10 ng/mL; AND Gleason score 6 or less; AND clinical stage T1c; AND presence of disease in fewer than 3 biopsy cores; AND <= 50% prostate cancer involvement in any core; AND PSA density <= 0.15 ng/mL/cm3. 
Low Risk - PSA < 10 ng/mL; AND Gleason score 6 or less; AND clinical stage T1 to T2a. 
Intermediate Risk - PSA 10 to 20 ng/mL; OR Gleason score 7; OR clinical stage T2b to T2c. Note: Patients with multiple adverse factors may be shifted into the high risk category. 
High Risk - PSA > 20 ng/mL; OR Gleason score 8 to 10; OR clinically localized stage T3a. Note: Patients with multiple adverse factors may be shifted into the very high risk category. 
Very High Risk - Clinical stage T3b to T4; OR primary Gleason pattern 5; OR more than 4 cores with Gleason score 8 to 10. (NCCN, 2015)

External beam radiotherapy - external beam radiotherapy refers to 3D conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), stereotactic body radiotherapy (SBRT), and proton beam therapy.

A higher score indicates appropriate treatment of patients with prostate cancer at low (or very low) risk of recurrence.
Only patients with prostate cancer with low (or very low) risk of recurrence will be counted in the performance denominator of this measure.

TBD

All patients, regardless of age, with a diagnosis of prostate cancer

Equals Initial Population at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy

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Patients who did not have a bone scan performed at any time since diagnosis of prostate cancer

Not Applicable

Documentation of reason(s) for performing a bone scan (including documented pain, salvage therapy, other medical reasons, bone scan ordered by someone other than reporting physician)

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

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