PD12-09 THE INCIDENCE OF ACTIVE SURVEILLANCE FOR PRIMARY MANAGEMENT OF LOW-RISK PROSTATE CANCER IN A STATE-WIDE QUALITY IMPROVEMENT COLLABORATIVE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized I1 Apr 2014PD12-09 THE INCIDENCE OF ACTIVE SURVEILLANCE FOR PRIMARY MANAGEMENT OF LOW-RISK PROSTATE CANCER IN A STATE-WIDE QUALITY IMPROVEMENT COLLABORATIVE Paul R. Womble, MD James E. Montie, MD Zaojun Ye, BS Susan M. Linsell, MHSA Brian R. Lane, andMD, PhD David C. MillerMD, MPH Paul R. WomblePaul R. Womble More articles by this author , James E. MontieJames E. Montie More articles by this author , Zaojun YeZaojun Ye More articles by this author , Susan M. LinsellSusan M. Linsell More articles by this author , Brian R. LaneBrian R. Lane More articles by this author , and David C. MillerDavid C. Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.981AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Given growing concerns that many men with low-risk prostate cancer are overtreated, active surveillance has emerged as a principle management option for these patients. Historic trends suggest that it is used in less than 25% of patients with low-risk disease; however little is known about its contemporary application, particularly in community-based practices. In this context, we report current rates of active surveillance among a population-based sample of men in the state of Michigan. METHODS Using data from the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry, we identified all men with a prostate cancer diagnosis who were entered into the registry from March 2012 through June 2013. Trained data abstractors recorded pertinent clinical data to a web-based registry. Patients were identified as having low-risk prostate cancer if PSA < 10, Gleason = 6 and cT1/cT2a. After limiting our analysis to practices with at least ten low-risk patients, we compared proportions of men receiving active surveillance as initial therapy across practices. RESULTS From March 2012 through June 2013, 2,022 patients with newly diagnosed prostate cancer were entered into the MUSIC registry. Among this group, 571 men (28.3%) met criteria for low-risk cancers, of which 541 (24.6%) were managed in practices with at least 10 low-risk prostate cancer patients. Patients in this cohort had a median age of 63 years (range 42 – 90) and a median PSA of 5.0 (range 0.3 – 9.9). The unadjusted proportion of patients receiving active surveillance for low-risk disease ranged from 25.0% to 79.2% across 15 practices (p=0.008), with an overall rate of 51.4%. After accounting for differences in patient characteristics, the adjusted probability remained highly variable across practices, ranging from 27.4% to 79.6% (p=0.016) and an overall rate of 50.8% (Figure). CONCLUSIONS Approximately 50% of men in Michigan with low-risk prostate cancer undergo active surveillance for initial therapy, which is appreciably higher than historically reported. The impact of these emerging practices will depend on validation of the duration of surveillance, quality of life and long-term cancer control outcomes. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e349-e350 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Paul R. Womble More articles by this author James E. Montie More articles by this author Zaojun Ye More articles by this author Susan M. Linsell More articles by this author Brian R. Lane More articles by this author David C. Miller More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...