Many low-risk PCa patients on AS may be lost to follow-up
"This study highlights the need for each practice to perform a self-audit of its AS protocol and take all necessary measures to ensure that patients are not lost during the monitoring period," writes Badar M. Mian, MD.
“Journal Article of the Month” is a new Urology Times section in which Badar M. Mian, MD (left), offers perspective on noteworthy research in the peer-reviewed literature. Dr. Mian is associate professor of surgery in the division of urology at Albany Medical College, Albany, NY.
Active surveillance (AS) for prostate cancer is included in virtually all the guidelines, and its use has been increasing steadily over the last decade. AS, requiring follow-up testing, has become the current standard of care for men with low-risk prostate cancer. According to Ginsburg et al, many men on AS are lost to follow-up and thus at potentially increased risk for disease progression and poor outcomes
The authors analyzed data in the Michigan Urologic Surgery Improvement Collaborative (MUSIC) registry, which includes patients with prostate cancer from 44 academic and community urology practices. For this study, they included those patients whose managing physician had recorded AS as the initial management strategy in the medical records.
Also by Dr. Mian:
Over a 6-year period from 2011 to 2017, there were 2,211 patients who were initially identified as being managed with AS. The median surveillance period was 32.1 months. The median age was 66.2 years, and other clinical and demographic characteristics were in line with other published reports. Lost to follow-up (LTFU) status was defined as a period of at least 18 months without any surveillance testing such as PSA, imaging, or prostate biopsy entered into the registry or medical record.
10% of patients lost to follow-up
The authors identified 217 patients (10%) as LTFU during a median follow-up of 32.1 months. African-American men and those with higher Charlson comorbidity index were associated with increased risk of LTFU. Most of the LTFU cases (126/217, 58%) occurred soon after or in the first 6 months after being identified as AS candidates in the registry. Also, there was wide variability in LTFU-free probability among different practices ranging from 52% to 99%.
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