MP38-15 DISCONTINUATION OF ACTIVE SURVEILLANCE WITHOUT RISK RECLASSIFICATION PRIOR TO TREATMENT

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP38-15 DISCONTINUATION OF ACTIVE SURVEILLANCE WITHOUT RISK RECLASSIFICATION PRIOR TO TREATMENT Mark Pressprich, Cullen Hudson, Ji Qi, Stephanie Ferrante, Khurshid Ghani, Brian Lane, Richard Sarle, Jason Hafron, Michael Cher, Alice Semerjian, Arvin George, Kevin Ginsburg, and For the Michigan Urological Surgery Improvement Collaborative Mark PressprichMark Pressprich More articles by this author , Cullen HudsonCullen Hudson More articles by this author , Ji QiJi Qi More articles by this author , Stephanie FerranteStephanie Ferrante More articles by this author , Khurshid GhaniKhurshid Ghani More articles by this author , Brian LaneBrian Lane More articles by this author , Richard SarleRichard Sarle More articles by this author , Jason HafronJason Hafron More articles by this author , Michael CherMichael Cher More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Arvin GeorgeArvin George More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , and For the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Guideline organizations support the use of active surveillance (AS) for all men with low risk (LR) and select men with favorable intermediate risk (FIR) prostate cancer (PC). Although encouraging AS as the initial approach for favorable-risk PC is an important first step in reducing overtreatment, this strategy is incomplete as it ignores another source of overtreatment: delayed treatment of men on AS who have not had risk reclassification. We evaluated the proportion of men that transitioned from AS to treatment without risk reclassification. METHODS: We reviewed the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry for men diagnosed with NCCN LRPC and FIRPC that underwent treatment after a period of AS to identify the proportion of men that did not have risk reclassification prior to treatment. Reclassification was defined as meeting any criteria for NCCN FIRPC for men initially diagnosed with LRPC and any criteria for NCCN unfavorable intermediate risk PC for men initially diagnosed with FIRPC. RESULTS: From 2013 to 2021, 2118 men in MUSIC underwent treatment after initial AS, of which 741 (35%) did not have risk reclassification prior to treatment. A higher proportion of men with FIRPC underwent treatment without risk reclassification compared with LRPC (50% vs. 29%, p<0.001). The proportion of men with LRPC undergoing delayed treatment decreasing from 60% in 2013 to 23% in 2021 (Figure 1). Alternatively, the proportion of men with FIRPC treated without risk reclassification has remained stable. CONCLUSIONS: The overall percent of patients leaving AS for treatment without risk reclassification has declined in MUSIC, likely due to an increasing acceptance and comfort with AS for favorable-risk PC. The proportion of men with FIRPC undergoing treatment without risk reclassification has remained relatively stable, which may be explained by the clinical uncertainty regarding a treatment threshold for these men on AS. While there remains uncertainty regarding when patients with FIRPC on AS should be treated, there are QI opportunities to reduce overtreatment in men with LRPC on AS, a group for which the urologic community has coalesced around the use of AS as the preferred approach. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e530 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Pressprich More articles by this author Cullen Hudson More articles by this author Ji Qi More articles by this author Stephanie Ferrante More articles by this author Khurshid Ghani More articles by this author Brian Lane More articles by this author Richard Sarle More articles by this author Jason Hafron More articles by this author Michael Cher More articles by this author Alice Semerjian More articles by this author Arvin George More articles by this author Kevin Ginsburg More articles by this author For the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...