PCa Active Surveillance Widely Used by Community Urologists

Recent study shows that 71% of prostate cancer patients with very-low-risk disease were placed on active surveillance.
Recent study shows that 71% of prostate cancer patients with very-low-risk disease were placed on active surveillance.

NEW ORLEANS—Active surveillance (AS) is widely used by community-based urologists to manage newly diagnosed localized prostate cancer (PCa), according to the findings of a study presented at the American Urological Association annual meeting.

In a retrospective investigation involving a chart review of 1,401 PCa patients treated in 8 large urology practices from January 2013 to March 2014, AS was the primary management strategy for 71% and 40% of patients with very-low-risk and low-risk disease, respectively, as defined by National Comprehensive Cancer Network (NCCN) criteria. Urologists placed 8% of patients with intermediate-risk disease on AS. The use of surgery and radiation was equivalent by risk group.

The study, which was conducted by the Large Urology Group Practice Association Benchmarking Committee, also showed that AS use varied by age group in a manner consistent with recommended principles of care. It was used in 23.2% of patients aged 55 years or less, 28.4% of those aged 56–65 years, and 32.5% of those aged 66–75 years. Race did not predict AS use.

Further analysis showed that compared with patients who had very-low-risk disease, those with low- and intermediate-risk disease had a significant 72% and 97% decreased odds of being managed with AS. Compared with patients aged 55 years or less, those aged 66–75 years had a significant 2.5-fold increased odds of being placed on AS.

“We have analyzed a large contemporaneous cohort of newly diagnosed prostate cancer patients, and found that community-based urologists practicing in large integrated groups have been quick to adopt evidence-based recommendations for management of lower-risk prostate cancer patients,” said lead investigator Jeremy Shelton, MD, MSHS, of Skyline Urology in Los Angeles. “Our data demonstrate that in a geographically diverse cohort of community urologists, the adoption rate of active surveillance as the initial treatment choice appears to be higher than in previously reported studies. However, there is variation between some practices, pointing to an opportunity for enhanced educational initiatives and ongoing quality improvement efforts.”

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