SUO 2017: Rates And Risk Factors Of Lost To Follow Up In Prostate Cancer Patients Managed With Active Surveillance

Washington, DC (UroToday.com) Introduction: Active surveillance (AS) has emerged as an appropriate management strategy for many men with prostate cancer (PC), however insufficient monitoring may lead to an increased risk of undesired outcomes. The authors therefore evaluated a large AS cohort across diverse practices in Michigan to determine rates of loss to follow-up (LTFU) and associated risk factors.

Methods: MUSIC maintains a prospective registry of PC patients from 44 academic and community urology practices within the state of Michigan. The authors identified all patients in the registry managed with AS from 2011-2015. LTFU was defined as any 18-month period where no pertinent surveillance information was identified in the medical record by trained data abstractors (i.e., no PSA, prostate CT/MRI, or prostate biopsy). LTFU events were stratified as either (1) prolonged loss to follow up (PLTFU): a LTFU event with no further data entered. Lastly, the authors fit a multivariable logistic regression models and compared adjusted rates of LTFU events across MUSIC practices.

Results: Out of the 2211 men enrolled on AS from 2011-2015, 217 (9.8%) had a LTFU event. Of these, 184 (8.3%) patients had PLTFU and 33 (1.5%) had IFU. African American (AA) patients were more likely than Caucasian patients to be LTFU (17.0% vs 7.4%, p<0.05). In multivariable analyses, both AA race (OR 2.29, 95% CI 1.38-3.82) and Charlson comorbidity index (CCI) of 1 or more (OR 1.75, 95% CI 1.10-2.76) were independently associated with an increased likelihood of LTFU.

Conclusion: Nearly ten percent of men placed on AS become LTFU, representing suboptimal implementation of this management strategy. Patient-specific factors associated with being LTFU include AA race and a greater rate of medical comorbidities. The authors state it is important to find the factors causing lower LFTU rates and implement them in a systematic way.

Presented by: Kevin Benjamin Ginsburg, Wayne State University Department of Urology, Detroit, MI, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC
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