EAU 2021: Can Prostate Cancer Follow-up Databases Safely Reduce Clinic Numbers

(UroToday.com) At the 2021 European Association of Urology (EAU) virtual annual meeting, Dr. Stephen Mark discussed aspects of a prostate cancer follow-up database to safely reduce patient clinic visits. Dr. Mark notes that there is generally a wide variation in prostate cancer follow-up, with options for follow-up including in-person clinic visits, telehealth, general practitioner (60% compliance) visits, patient e-portals, and no formal follow-up. Generally, follow-up for prostate cancer patients includes PSA surveillance and symptom follow-up.

Dr. Mark notes that New Zealand has a population of 5 million people, with approximately 4,000 new cases of prostate cancer diagnosed per year. Canterbury Urology covers a population of 750,000 over four sites. Their group has developed a ‘stable prostate cancer database’, which includes those post-curative treatments, those on watchful waiting, and men receiving hormone therapy. The algorithm for follow-up involves both urologists and administrators, as highlighted below:

 

EAU2021_Mark_Clinic Numbers 

 

For their study, Dr. Mark noted that the aim was to review the total number of patients in the database from 2003-2021 at two locations (1 public, 1 private). The goals of the study were to (i) outline reasons for patient removal and percent lost to follow-up, (ii) determine clinic appointments saved, and (iii) discuss the scalability of the database. The total number of patients in the database in both the public and private databases are as follows:

 

EAU2021_Mark_Clinic Numbers_public_private 

 

Overall, <1% of patients were lost to follow. The reasons for leaving the database in the public domain are as follows:

 

EAU2021_Mark_Clinic Numbers_publicdomain 

 

Additionally, as follows are the reasons for leaving the database in the private domain:

 

EAU2021_Mark_Clinic Numbers_privatedomain 

 

For appointments saved, the results were as follows:

  • Public
    • Total: 19,226
    • Average/year: 1,130/year
    • 2020: 1,370
    • Admin: 14 hours/week
  • Private
    • Total: 16,529
    • Average/year: 970/year
    • 2020: 1,700
    • Admin: 12 hours/week

 

More recently, Dr. Mark’s group has instituted an active surveillance database. The on protocol definition for active surveillance is: (i) age <= 75 years of age, (ii) diagnosed on biopsy (not TURP), (iii) PSA <= 15 ng/mL, (iv) % in the single core <50%, (v) number of cores positive <= 3 cores, (vi) Gleason Grade <= 3+3, and (vii) T stage <= 2a. Dr. Mark notes that this database has >99% compliance with follow-up, with six monthly compliance reports.

 

Dr. Mark summarized his talk noting the following points:

  • A database for follow-up of prostate cancer patients demonstrates an efficient, compliant and equitable tool
  • Allows for visible outcomes to patients and General Practitioners
  • Longer term follow-up is available for QI and QA audits
  • Patients are also available for research studies
  • Prostate cancer follow-up databases may be scalable to other sites with either central or peripheral administrators

 

Several take home messages are as follows:

  • A ‘stable prostate cancer database’ is administrator run and can safely reduce clinic numbers
  • The initial evidence for the active surveillance database is that it provides compliant patient follow-up

 

Presented by: Stephen Mark, MD, Urologist, and Chair of the New Zealand Section Urology and the clinical leader of the New Zealand Prostate Registry, Christchurch, New Zealand

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2021 European Association of Urology, EAU 2021- Virtual Meeting, July 8-12, 2021.