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