Diagnostic Imaging in Low-Risk Prostate Cancer: More Harm Than Good?

INTRODUCTION: Despite guidelines recommending that staging imaging is not needed in very low-risk (VLR) and low-risk (LR) prostate cancer (PCa), there is concern for overutilization in these risk groups. We investigate utilization of staging imaging and implications of findings in newly diagnosed VLR and LR PCa patients. METHODS: A total of 493 patients diagnosed with PCa between 2011 and 2017 were stratified according to American Urological Association and National Comprehensive Cancer Network® VLR and LR groups. Computerized tomography (CT), magnetic resonance imaging and bone scan performed at diagnosis was captured and guidelines compliance was evaluated. The significance of radiologist interpreted imaging findings, by imaging type, were classified as normal, nonurological, nonsignificant urological and PCa significant. RESULTS: Greater than 75% of patients in the VLR and LR groups underwent imaging at time of diagnosis. Bone scan was performed in 30% of patients, none of which noted PCa-significant findings, and the majority were normal. CT was utilized in 38% of patients, with only 3 showing PCa-significant findings. Ten CTs showed nonurological/nonsignificant urological findings causing further evaluation. Magnetic resonance imaging was the most utilized scan in low-risk groups, occurring in 70% of patients. Although the majority were normal, 25 scans showed nonsignificant urological findings while only 7 showed PCa-significant findings. CONCLUSIONS: Among VLR and LR PCa patients, there is high overutilization of imaging with most studies yielding minimal PCa-significant findings and further evaluation for incidental observations. This exploratory analysis gives awareness that staging imaging in VLR and LR PCa patients may do more harm than good.

Surgical Preparation by Urology Trainees in 2021: The Interplay of Video and Print Resources.

INTRODUCTION: We investigate urology trainee preparation for surgical procedures by querying type and degree of video sources used and combination with traditional print materials for preparation of surgical procedures. METHODS: An Institutional Review Board-approved 13-question REDCap® survey was distributed to 145 American College of Graduate Medical Education-accredited urology residency programs. Social media were also used to recruit participants. Results were collected anonymously and analyzed using Excel®. RESULTS: A total of 108 residents completed the survey. The majority (87%) reported using videos for surgical preparation including, YouTube (93%), American Urological Association (AUA) Core Curriculum videos (84%) and institutional or attending-specific videos (46%). Video selection was based on quality (81%), length (58%) and the site of video creation (37%). Video preparation was reported predominantly for minimally invasive surgery (95%), subspecialty procedures (81%) and open procedures (75%). The most common print sources reported include Hinman's Atlas of Urologic Surgery (90%), Campbell-Walsh-Wein Urology (75%) and the AUA Core Curriculum (70%). When asked to rank their overall top 3 sources, 25% of residents reported YouTube as their primary source and 58% included it in their top 3. Only 24% of residents reported being aware of the AUA YouTube channel, while 77% were aware of the video section of the AUA Core Curriculum. CONCLUSIONS: Urology residents use video resources to prepare for surgical cases, with a heavy reliance on YouTube. AUA-curated video sources should be highlighted in the resident curriculum as the quality and educational content of YouTube videos are variable.