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Active Surveillance in Newly Diagnosed Prostate Ca

J Urol; ePub 2019 Jan 31; Botejue, Abbott, et al

In a cohort of men with newly diagnosed prostate cancer, more than half with low-risk disease were treated with active surveillance; however, substantial variation in rates were observed among practices and providers. Researchers analyzed data from the PURC (Pennsylvania Urologic Regional Collaborative) to determine the rates of active surveillance among men with newly diagnosed NCCN (National Comprehensive Cancer Network) very low, low, or intermediate prostate cancer and compared the rates among participating practices and providers. They found:

  • A total of 1,880 men met inclusion criteria.
  • 57.4% underwent active surveillance as the initial management strategy.
  • Increasing age was significantly associated with active surveillance.
  • Adverse clinicopathological variables were associated with decreased active surveillance.
  • Substantial variation in active surveillance utilization was observed among practices and providers.

Citation:

Botejue M, Abbott D, Danella J, et al. Utilization of active surveillance as initial management of newly diagnosed prostate cancer: Data from the PURC. [Published online ahead of print January 31, 2019]. J Urol. doi:10.1016/j.juro.2018.10.018.

Commentary:

Active surveillance of patients with appropriately risk-stratified localized prostate cancer is now widely recommended. Appropriate application of these guidelines may not only result in optimal patient care but may save cost for the health enterprise as a whole. Botejue et al. present an important evaluation of the landscape of implementation of these recommendations in a collaborative of urologic practices. It is encouraging that over 50% of the participant cohort appropriately underwent active surveillance. However, this can be improved upon, and the authors identified variation amongst practices. This finding may contribute to further barrier analysis and implementation studies aimed at improving active surveillance rates. —Mark A. Klein, MD