Risk factors for metastatic prostate cancer: A sentinel event case series.

Abstract

235 Background: After 25 years of declines in late stage prostate cancer (PCa), evidence is mounting that an increasing fraction of men may present with metastatic disease, well after they might have been treated with local therapy. Identification of modifiable risk factors may allow for systems-level interventions to reduce delayed diagnoses. Methods: We performed an in-depth case series analysis of 15 patients who presented with metastatic disease at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center using root cause analysis, a tool commonly employed to understand the root cause of dangerous adverse events. Results: Key factors in late diagnosis include lack of insurance, lack of routine PSA testing, comorbidities, reluctance of patients to follow up actionable PSA as well as aggressive disease. Three patients had aggressive disease that would likely not have been discovered at an early stage regardless screening. However, analysis of the remaining 12 patients illuminated how health system factors led to missing important diagnostic information might have led to diagnosis of PCa at an earlier stage. Conclusions: These cases emphasize the need for systems-based approaches to early diagnosis of prostate cancer, which may prevent men from missing the opportunity to cure prostate cancer at an early stage. These results show how one might target PCa screening recommendations to more fully reflect key risk factors such as race and family history.