AUA 2020: APP Prostate Cancer Active Surveillance Clinic

( At the AUA 2020 Virtual conference, Kenny Lin presented on prostate cancer active surveillance at Memorial Sloane Kettering Cancer Center. Mr. Lin is a nurse practitioner who practices in Sloan Kettering’s PCa active surveillance (AS) program.  Because of the growth of AS in men with PCa, the AS service was expanded to incorporate APPs (Advanced Practice Providers).  With urology support, the AS APP program involved independent clinics that include ongoing patient education and counseling, physical exams, ordering of diagnostic tests and performing TRUS and MR-targeted prostate biopsies. APP biopsy training with the urologist mentor occurred over a year, at which time the APP was to perform the biopsies independently. Follow-up schedule for men on AS is detailed in this table. 

Mr. Lin and the AS clinical team evaluated the impact of the APP-directed service by focusing on patient outcomes, comparing the APPs (n=153) and their mentor urologist (n=1425). Outcomes of interest included biopsy-related complications and patient acceptance of APP-perfumed biopsies.  Between 2000 and 9/2019, 2341 patients had AS FU visits with 1333 biopsies. Overall biopsy complications rates were low with up to 1.5% of infectious complications with only 1 documented case attributed to an APP. Overall, no differences between the two providers. Another interesting finding was no meaningful differences between “no-show” visits when comparing visits by APPs and those by the urologist, indicating patient acceptance of APP-performed biopsies.   

In summary, the Sloan Kettering APP-lead AS clinics had very positive outcomes with neither no significant differences in disease assessment nor higher rate of complications when compared to urologist practice.  These services were well-received by patients. This lecture highlights the expanding role of APPs in urology practices. 

Presented by: Xin Lin (Kenny) MS, RN, AGNP-BC, OCN, Prostate Cancer Active Surveillance Program, Memorial Sloan Kettering Cancer Center, New York, NY

Written by: Diane Newman, DNP, ANP-BC, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health

Related Content: Nurse Practitioners and Physician Assistants: The Future of Urology - Diane Newman