New guidelines are helping Michigan urologists decide which prostate cancer patients should have computed tomography (CT) scans to see if their disease if spreading.
The practical effect of the guidelines has been impressive. Urologists have used them to increase the rate of aggressive cancer detection and reduce by more 40 percent the number of patients who have diagnostic bone and CT scans. The reduction in scans saved patients and insurers around $275,000.
University of Michigan researchers representing different fields drew up the guidelines.
“Traditionally, urologists have relied on their individual expertise and experience to decide who should be scanned,” Dr. Brian Denton said in a news release. “These guidelines provide a new tool that will help them administer scans to more people who do need them and fewer people who don’t. And the fact that we’re using actual data from the state of Michigan, where the urologists and patients reside, is critically important.”
Denton is both a professor of industrial and operations engineering at the university’s College of Engineering and professor of urology at the university’s Medical School.
“We were pleased to see that this intervention led to such meaningful results,” said Dr. David Miller, another urology professor. “I think it shows the power of collaboration between medicine and engineering, and I’m looking forward to seeing how data and predictive analytics can help improve outcomes and efficiency in other areas as well.”
Researchers decided to do a study on the use of the guidelines to predict whether a prostate cancer patient would develop an aggressive form of the disease. They starting by giving the guidelines on laminated cards to nearly 85 percent of urologists in Michigan.
The guidelines specify maximum thresholds for aggressive prostate-detection parameters. One is a patient’s prostate-specific antigen, or PSA, level. Another is a Gleason score, which evaluates a patient’s prognosis using prostate biopsy tissue. And another is the stage of a patient’s cancer.
Researchers told doctors that patients below the cut-off values could forgo the scanning examinations, while those above the values should be tested.
The team examined the medical records of patients who had had bone or CT scans in their study. They noted risk factors, age, type of prostate cancer, and PSA levels.
Patients’ records came from the physician-led Michigan Urological Surgery Improvement Collaborative. Under the program, urologists in Michigan collect and share patient information.
The researchers used a mathematical model to predict which prostate cancer patients were at risk of developing an aggressive form of the disease.
They are now looking at strategies for persuading doctors in other states to adopt guidelines. Since risk factors vary between regions, expanding the program would involve more than just using the Michigan guidelines, researchers said.
The team is also creating a smartphone app that can calculate a patient’s risk of developing an aggressive form of the disease. It will be based on risk factors a physician inserts in the app.
“We would need to take data from patients in a given area and recalibrate our model to fit that data,” Miller said. “That’s not difficult—the hard part is getting the data. Because of MUSIC, we have access to a much higher level of data here in Michigan than most states. I think it’s a great example that other states could emulate.”