ABSTRACT
Objective
To characterize the contemporary management of prostate cancer patients in large community
practices. The optimal management of incident prostate cancer has changed in the last
decades to include active surveillance for a large number of men. At the same time,
many community practices have merged into larger groups. The adoption of evidence-based
guidelines is of increasing importance, but poorly understood in this newer practice
setting.
Methods
We conducted a retrospective chart review of men ≤75 years old with very low, low,
and intermediate risk incident prostate cancer diagnosed between December 1, 2012
and March 31, 2014, in 9 geographically distributed large urology practices. We used
descriptive statistics and multivariable regression to assess predictors of primary
management choice.
Results
2029 men were in the study cohort. A majority were white (68.7%). Total of 45.7% had
intermediate risk, 36.2% low risk, and 17.9% had very low risk disease cancer. Active
surveillance (AS) was the initial treatment for 74.7% of men with very low risk disease,
43.5% of men with low risk disease and 10.8% of men with intermediate risk disease.
The probability of choosing surgery vs radiation for men with lower and intermediate
risk disease was 0.54 (95% confidence interval: 0.42, 0.65) and 0.59 (95% confidence
interval: 0.48, 0.69), respectively.
Conclusion
We found that the initial management of lower risk prostate cancer in large community
urology practices largely followed clinical characteristics, widespread adoption of
active surveillance, and equal use of surgery and radiation. However, some variation
by practice suggested a need for further investigation and continued improvement.
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Article info
Publication history
Published online: April 04, 2019
Accepted:
January 31,
2019
Received:
September 18,
2018
Identification
Copyright
Published by Elsevier Inc.
