San Diego—Concordance with National Cancer Comprehensive Network (NCCN) recommendations about follow-up during active surveillance for low-risk prostate cancer is generally low across urology practices in Michigan, reported researchers from the Michigan Urological Surgery Improvement Collaborative (MUSIC) at the AUA annual meeting in San Diego.
Failure to perform follow-up biopsy is the driving factor.
The study analyzed data for 513 patients seen in 16 of the 42 urology practices comprising MUSIC. Included in the study were practices that had enrolled more than 10 patients in active surveillance between January 2012 and September 2013, and patients who had 2 years of follow-up on active surveillance after their prostate cancer diagnosis.
Concordance with NCCN guidelines was defined by receipt of three PSA measurements and one follow-up biopsy during the 2 years on active surveillance. The analyses showed that across the 16 practices, concordance rates varied widely, ranging from 10.0% to 67.5%. The average, however, was only 26.5%.
Analyses focusing on the source of guideline discordance showed that re-biopsy was consistently being underperformed. The proportion of men who did not undergo repeat biopsy ranged from about 55% to almost 100% across the different practices, but the rate did not differ significantly across the 16 practices, and the median was 82%.
“Use of active surveillance for management of low-risk prostate cancer is increasing, but little is known about longitudinal practice patterns for men on active surveillance,” said first author Amy Luckenbaugh, MD, urology resident at the University of Michigan, Ann Arbor, who presented the data.
“The findings of our study highlight a need to standardize pathways for active surveillance. Although it remains to be determined whether the protocol should involve continued use of annual biopsy as recommended by the NCCN and therefore a focus on improving biopsy rates or finding some alternatives that are more patient friendly, we at MUSIC feel it is important that patients using active surveillance for managing prostate cancer are followed appropriately,” added Dr. Luckenbaugh, who worked on the study with David Miller, MD, MPH, and colleagues.