Volume 51 | Number 3 | June 2016

Abstract List

Danil V. Makarov M.D., M.H.S., Elaine Y. C. Hu M.S., Dawn Walter M.P.H., R. Scott Braithwaite M.D., M.Sc., Scott Sherman M.D., M.P.H., Heather T. Gold Ph.D., Xiao‐Hua Andrew Zhou Ph.D., Cary P. Gross M.D., Steven B. Zeliadt Ph.D.


To determine the frequency of appropriate and inappropriate prostate cancer imaging in an integrated health care system.

Data Sources/Study Setting

Veterans Health Administration Central Cancer Registry linked to electronic medical records and Medicare claims (2004–2008).

Study Design

We performed a retrospective cohort study of patients diagnosed with prostate cancer ( = 45,084). Imaging (,, bone scan, ) use was assessed among patients with low‐risk disease, for whom guidelines recommend against advanced imaging, and among high‐risk patients for whom guidelines recommend it.

Principal Findings

We found high rates of inappropriate imaging among men with low‐risk prostate cancer (41 percent) and suboptimal rates of appropriate imaging among men with high‐risk disease (70 percent). Veterans utilizing Medicare‐reimbursed care had higher rates of inappropriate imaging [: 1.09 (1.03–1.16)] but not higher rates of appropriate imaging. Veterans treated in middle [: 0.51 (0.47–0.56)] and higher [: 0.50 (0.46–0.55)] volume medical centers were less likely to undergo inappropriate imaging without compromising appropriate imaging.


Our results highlight the overutilization of imaging, even in an integrated health care system without financial incentives encouraging provision of health care services. Paradoxically, imaging remains underutilized among high‐risk patients who could potentially benefit from it most.