Abstract
Objectives
To determine the 3-year outcomes of men with prostate cancer managed with active surveillance
(AS) in a cohort of geographically diverse community-based urology practices. AS is
the management of choice for a majority of men with lower risk prostate cancer.
1
,
2
,
3
Little is known about the contemporary “real-world” follow-up and adherence rates
in the most common setting of urologic care, community (private) practice.
4
Methods
We retrospectively evaluated outcomes for men diagnosed between January 1, 2013 and
May 31, 2014 with National Comprehensive Cancer Network (NCCN) very low, low and intermediate
risk prostate cancer who selected AS in 9 large community urology practices. We used
univariate and multivariate analyses to describe associations between race, age, insurance
status, family history, comorbidity, clinical stage, Gleason score, NCCN risk-group,
and PSA density with discontinuation of AS.
Results
Five hundred and forty-eight men on AS were followed for a median of 3.35 years. 89%
(492) continued to follow-up with diagnosing practice. 32% (171) discontinued AS.
On multivariate analysis, increasing NCCN risk classification (Hazard ratio [HR] 1.65,
P = 0.02 and HR 2.09, P < 0.01 for low and intermediate risk vs very low risk) was significantly associated
with discontinuation. Among those who discontinued AS, surgery and radiation were
utilized equally (47% and 53%, respectively, P = 0.48).
Conclusion
In this community-based cohort of men on AS, a minority was lost to follow-up and
adherence to AS was similar to other reports. Disease characteristics more than sociodemographic
characteristics correlated with adherence to AS, while surgery and radiotherapy were
utilized equally among those discontinuing AS, both suggesting guideline concordant
practice of medicine.
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Article info
Publication history
Published online: April 25, 2019
Accepted:
April 15,
2019
Received:
October 18,
2018
Identification
Copyright
Published by Elsevier Inc.
