Remarkably, said Dr. Shelton, nearly 90% of men continued their care with their diagnosing practice.
“Given that we’re talking about a real-world cohort, I was surprised that so many patients continued care in the diagnosing practice,” he observed.
Other key observations reported by Dr. Shelton:
- Two-thirds of men remained on active surveillance at 3 years.
- Eighty-six percent had PSA testing at least yearly, while only a little over one-third had a repeat biopsy by 18 months.
- The most common causes for seeking curative therapy were increase in Gleason score (55%), rise in PSA (15%), increase in disease volume (14%), and stress of living with cancer (0.6%).
Under the leadership of Dr. Shelton; Philip Buffington, MD, of The Urology Group, Cincinnati; and LUGPA President Neal D. Shore, MD, of Carolina Urologic Research Center, Myrtle Beach, SC, the study developed from a LUGPA quality improvement effort. As, Dr. Shelton explained, “We wanted to better understand the management of diagnosed prostate cancer and, in particular, the utilization of active surveillance.”
“Given that all participating practices volunteered significant time and resources to completing this evaluation, I think our success is a wonderful testament to the interest and commitment among participating practices to understand and improve care delivery,” he said. “Furthermore, the experience gained bodes well for future efforts.”
Dr. Shelton said the team is working on two papers from the project and expects to submit them for peer-reviewed publication by the end of 2017.
“We’ll try to get more funding and continue the study and conduct others,” he said, “because there is a lot more to learn, particularly as physicians grapple with how best to deliver care in the setting of major health policy reforms. It’s exciting to work directly with practices to create a health services-oriented research network capable of describing a detailed picture of the contemporary delivery of urologic care in the private practice community.”
Study site participants were:
- Carolina Urology Partners, PLLC, Charlotte, NC
- Atlantic Urology Clinics, Myrtle Beach, SC
- Urology of Indiana, Indianapolis
- Oregon Urology Institute, Eugene
- The Urology Center of Colorado, Denver
- Skyline Urology, Los Angeles
- Virginia Urology, Richmond
- Genesis Healthcare Partners, San Diego
- The Urology Group, Cincinnati.
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