AUA 2017: Determinants of Default From Follow-Up Care in a Prostate Cancer Screening Program

Boston, MA ( Dr. Ferretti and colleagues from New York Medical College presented their work assessing determinants of defaulting from a prostate cancer screening program today at the 2017 AUA Annual Meeting’s podium session on prostate cancer detection and screening. As has been stressed in other sessions at the Annual meeting, detection does not necessarily equal treatment, however for a subset of men with intermediate or high risk disease, treatment may be necessary and recommended.

The primary outcome of this study was to identify the proportion of men and predictors of loss of follow-up care after a positive prostate biopsy in a single-institution, retrospective cohort study. Loss of follow-up care was defined as men who failed to return for treatment or follow-up discussion after diagnosis of prostate cancer, but did not include men that sought treatment at another hospital. Over a five-year period, there were 574 patients that had at least one PSA >4 ng/mL of which 210 patients subsequently underwent a prostate biopsy. Prostate cancer was detected in 85 men (41%), of which 17 (20%) men failed to follow-up after diagnosis. Compared to men that followed-up, men that defaulted from follow-up were younger (62 vs 66 years, p=0.04). Furthermore, defaulters from follow-up were more likely to be uninsured, self-identify as Latino, and more likely to have an ‘unspecified’ primary care provider at the author’s institution. Among defaulters, 81% had clinically significant prostate cancer (Gleason ≥7). Using multivariable regression modeling, significant variables associated with defaulting from follow-up included younger age, insurance status, race and lack of primary care provider access. A strength of this study is the unique primary objective of identifying men that fail to follow-up after prostate cancer diagnosis. A possible limitation of the study is the small cohort of men with diagnosed prostate cancer and thus small number of men defaulting from follow-up.

Although a small retrospective analysis, this study derives important hypotheses that suggest that (i) younger men may ‘fear’ being diagnosed with prostate cancer and thus abandon further follow-up and treatment, and (ii) men with a poor social construct (minority race, uninsured, and without a primary care provider) may require additional support and social work assistance to navigate post-diagnosis follow-up and subsequent treatment. Future larger prospective studies should focus on specific reasons for lack of follow-up in these high risk individuals.

Presented By: Mark Ferretti, New York Medical College, Valhalla, NY, USA

Co-Authors: Michael Goltzman, Akhil Saji, Neel Patel, Denton Allman, Sean Fullerton, Gerald Matthews, John Phillips

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA