Prostate Cancer Active Surveillance Quality Questioned

Only 4.5% of Medicare patients on active surveillance or watchful waiting for prostate cancer are monitored as closely as they should be.
Only 4.5% of Medicare patients on active surveillance or watchful waiting for prostate cancer are monitored as closely as they should be.

Less than 5% of prostate cancer (PCa) patients aged 65 years and older who choose active surveillance or watchful waiting receive recommended follow-up care, defined as a PSA test and doctor visit every 6 months and a repeat prostate biopsy within 2 years of diagnosis, according to a new study of Medicare patients.

In fact, men who had aggressive treatment for PCa were more likely than untreated men to receive intensive follow-up.

“Our study suggests that before we advise our patients to pursue active surveillance for their prostate cancer, we should be certain that we are committed to closely monitoring the cancer with a repeat biopsy and more frequent PSA testing and physical exams,” lead researcher Karim Chamie, MD, MSHS, of the University of California Los Angeles, told Renal & Urology News.

Dr Chamie and his colleagues identified more than 37,000 seniors diagnosed with PCa from 2004 to 2007 using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Of these, 3,656 men chose watchful waiting or active surveillance. Those with advanced age or comorbidities were less likely to select monitoring.

According to results published online in Cancer, patients on active surveillance or watchful waiting had an average of just 2.6 PSA tests and 4.6 doctor visits within 2 years. Their Gleason score had little impact. Only 13% had a second prostate biopsy during that period. Patients treated for PCa, by contrast, received more intense monitoring based on Gleason score.

The overall rate of men choosing active surveillance is still quite low, the investigators concluded. The quality of monitoring that occurs with active surveillance or watchful waiting is also uncertain.

Researchers were unable to distinguish watchful waiting from active surveillance, which is a limitation. 

Source

  1. Chamie K, Williams SB, Hershman DL, et al. Population-Based Assessment of Determining Predictors for Quality of Prostate Cancer Surveillance. Cancer. doi: 10.1002/cncr.29574.
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