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Three-year Active Surveillance Outcomes in a Contemporary Community Urology Cohort in the United States

      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.
      • Sanda MG
      • Cadeddu JA
      • Kirkby E
      • et al.
      Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options.
      • Mottet N
      • Bellmunt J
      • Bolla M
      • et al.
      EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent.
      Network NCC
      NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Prostate Cancer.
      Little is known about the contemporary “real-world” follow-up and adherence rates in the most common setting of urologic care, community (private) practice.
      • Cooperberg MR
      • Carroll PR.
      Trends in management for patients with localized prostate cancer, 1990-2013.

      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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