MP15-04 VARIATION IN ACTIVE SURVEILLANCE FOLLOW-UP OVER TWO YEARS IN DIVERSE UROLOGY PRACTICES

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II1 Apr 2016MP15-04 VARIATION IN ACTIVE SURVEILLANCE FOLLOW-UP OVER TWO YEARS IN DIVERSE UROLOGY PRACTICES Amy Luckenbaugh, MD Gregory Auffenberg, MD Scott Hawken, MS Apoorv Dhir, BBA Susan Linsell, MHSA Sanjeev Kaul, andMD David MillerMD, MPH Amy LuckenbaughAmy Luckenbaugh More articles by this author , Gregory AuffenbergGregory Auffenberg More articles by this author , Scott HawkenScott Hawken More articles by this author , Apoorv DhirApoorv Dhir More articles by this author , Susan LinsellSusan Linsell More articles by this author , Sanjeev KaulSanjeev Kaul More articles by this author , and David MillerDavid Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2528AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Little is known about longitudinal follow-up patterns for men on active surveillance (AS) for prostate cancer (CaP) or how this compares with guideline recommendations. In this context, we examined the rates of conversion to secondary therapy, and the frequency of follow-up PSA tests and prostate biopsy among men managed with AS in the diverse academic and community urology practices comprising the Michigan Urological Surgery Improvement Collaborative (MUSIC). METHODS MUSIC is a consortium of 42 urology practices that maintains a prospective clinical registry with detailed and validated clinical data for all patients diagnosed with CaP. For this analysis, we identified all patients that entered AS and had at least two years of follow-up in the same practice. We first determined the percentage of patients who transitioned to secondary therapies. Next, we calculated the proportion of AS patients who received the minimum suggested 2-year follow-up based on NCCN recommendations: at least 3 PSA tests and one repeat biopsy. We then compared the proportion of patients receiving recommendation concordant AS follow-up at the participating sites. RESULTS We identified 513 patients that entered AS in MUSIC practices from 1/2012 to 9/2013. The median age of the cohort was 66, median PSA was 5.3 ng/mL (IQR 4.1-7.5 ng/mL), 75% of patients had Gleason ≤6 disease. Across the entire cohort, 15.6% transitioned to a secondary-treatment before reaching 2 years of follow-up (median time to treatment = 13.4 months), with 63% of these patients undergoing prostatectomy. At a practice level, rates of treatment varied widely ranging from 0 to 33% (p=0.002). Overall, 20.2% of patients entering AS received guideline-concordant PSA and biopsy surveillance over 2 years of follow-up; however, this proportion varied widely across MUSIC practices, ranging from 9.1% to 55.1% (p<0.001) (Figure 1). CONCLUSIONS Among MUSIC practices, there is wide variation in the proportion of men meeting guideline recommendations for follow-up PSA testing and repeat biopsy, as well as in the likelihood of transitioning to cancer-directed therapy. These data highlight the need for standardized clinical pathways for AS; moreover, understanding the strategies used by high-performing practices may provide a useful foundation for population-level QI initiatives. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e153 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Amy Luckenbaugh More articles by this author Gregory Auffenberg More articles by this author Scott Hawken More articles by this author Apoorv Dhir More articles by this author Susan Linsell More articles by this author Sanjeev Kaul More articles by this author David Miller More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...