MP4-03 CONTEMPORARY ACTIVE SURVEILLANCE RATES FOR NEWLY DIAGNOSED PROSTATE CANCER PATIENTS IN COMMUNITY UROLOGY PRACTICES

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2015MP4-03 CONTEMPORARY ACTIVE SURVEILLANCE RATES FOR NEWLY DIAGNOSED PROSTATE CANCER PATIENTS IN COMMUNITY UROLOGY PRACTICES Jeremy Shelton, Phillip Buffington, Alec Koo, and Neal Shore Jeremy SheltonJeremy Shelton More articles by this author , Phillip BuffingtonPhillip Buffington More articles by this author , Alec KooAlec Koo More articles by this author , and Neal ShoreNeal Shore More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.146AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) is an evidence-based option for the management of men with lower risk prostate cancer (PCa), There is, however, a paucity of data on its contemporary use - particularly in community-based urology practices- and concern exists regarding overtreatment. We sought to characterize the contemporary use of AS in a geographically diverse population of community-based urology practices. METHODS We performed a retrospective chart abstraction in 8 urology practices from 7 states (California, Colorado, Oregon, Ohio, Indiana, North Carolina and South Carolina), analyzing initial treatment choices among men ≤75 years old diagnosed during 2013 and 2014 with very low, low and intermediate risk prostate cancer, as per National Comprehensive Cancer Network (NCCN) criteria. A minimum of 6 months of documented follow-up from initial diagnosis was mandated for inclusion. AS was defined as either the specific documentation of AS in the chart, or, in the absence of documented treatment, as the occurrence of at least one PSA and one office visit within 6 months of diagnosis. We performed univariate analysis with the chi-square test and multinomial regression to evaluate the correlation of NCCN risk group, race, age, and urology practice on treatment choice. RESULTS Of 2464 incident cases, 1401 met inclusion criteria and 252 (17.3%) had very low-, 526 (36.1%) low- and 623 (42.7%) intermediate risk disease. The mean age was 63.6; 72.3% were white, 12.37% black, 4.2% other and 10.3% unknown. Initial primary therapeutic decisions are shown in the table. In multivariate analysis, risk group (p<0.001), age (p<0.001) and urology practice (p<0.001) predicted choice of active surveillance, while race (p=0.43) did not. Surgery and radiation use was equivalent within risk groups, with a trend toward higher use of surgery among men with intermediate risk disease, of whom 44.6% received surgery and 32.2% received radiation (p<0.06). CONCLUSIONS This contemporary analysis of 1401 patients from 8 geographically diverse, community-based large urology group practices within the US demonstrates a high adoption of active surveillance as an initial choice for men with newly diagnosed PCa. Variation in the rate of AS between practices may be an opportunity for educational benchmarking. Primary therapy choice by NCCN∗ risk group among men with incident prostate cancer in 2013 and 2014 treated in community urology practices Primary Therapy Very Low, n (%) Low, n (%) Intermediate, n (%) Total, n (%) Active surveillance 177 (70.2) 206 (39.2) 48 (7.7) 431 (30.1) Surgery 28 (11.1) 147 (28.0) 278 (44.6) 453 (32.3) Radiotherapy 30 (11.9) 125 (23.8) 207 (32.2) 362 (25.8) No follow-up 12 (4.8) 34 (6.5) 53 (8.5) 99 (7.1) Other 5 (2.0) 14 (2.7) 37 (5.9) 56 (4.0) Total 252 526 623 1,401 ∗ National Comprehensive Cancer Network © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e27-e28 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeremy Shelton More articles by this author Phillip Buffington More articles by this author Alec Koo More articles by this author Neal Shore More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...