Contemporary Management of Incident Prostate Cancer in Large Community Urology Practices in the United States.

To characterize the contemporary management of prostate cancer patients in large community practices. The optimal management of incident prostate cancer has changed in the last decades to include active surveillance for a large number of men. At the same time, many community practices have merged into larger groups. The adoption of evidence-based guidelines is of increasing importance, but poorly understood in this newer practice setting.

We conducted a retrospective chart review of men ≤75 years old with very low, low and intermediate risk incident prostate cancer diagnosed between December 1, 2012 and March 31, 2014, in nine geographically distributed large urology practices. We used descriptive statistics and multivariable regression to assess predictors of primary management choice.

2029 men were in the study cohort. A majority were White (68.7%). 45.6% had Intermediate risk, 36.2% low risk, and 17.9% had very low risk disease cancer. AS was the initial treatment for 74.7% of men with very low risk disease, 43.5% of men with low risk disease and 10.8% of men with intermediate risk disease. The probability of choosing surgery vs. radiation for men with lower and intermediate risk disease was 0.54 (95% CI: 0.42, 0.65) and 0.59 (95% CI: 0.48, 0.69), respectively.

We found that the initial management of lower risk prostate cancer in large community urology practices largely followed clinical characteristics, widespread adoption of AS, and equal use of surgery and radiation. However, some variation by practice suggested a need for further investigation and continued improvement.

Urology. 2019 Apr 04 [Epub ahead of print]

Jeremy B Shelton, Phil Buffington, Richard Augspurger, Franklin Gaylis, Todd Cohen, Bryan Mehlhaff, Ronald Suh, Timothy J Bradford, Lorna Kwan, Alec S Koo, Neal Shore

UCLA. Electronic address: ., The Urology Group. Electronic address: ., The Urology Center of Colorado. Electronic address: ., Genesis Healthcare Partners. Electronic address: ., Carolina Urology Partners. Electronic address: ., Oregon Urology Institute. Electronic address: ., Urology of Indiana. Electronic address: ., Virginia Urology. Electronic address: ., UCLA; The Urology Group; The Urology Center of Colorado; Genesis Healthcare Partners; Carolina Urology Partners; Oregon Urology Institute; Urology of Indiana; Virginia Urology; Skyline Urology; Atlantic Urology Clinics. Electronic address: ., Skyline Urology. Electronic address: ., Atlantic Urology Clinics. Electronic address: .