Three-year active surveillance outcomes in a contemporary community urology cohort in the United States.

To determine the 3-year outcomes of men with prostate cancer managed with active surveillance (AS) in a cohort of geographically diverse community-based urology practices. AS is the management of choice for a majority of men with lower risk prostate cancer. 1,2,3 Little is known about the contemporary "real-world" follow-up and adherence rates in the most common setting of urologic care, community (private) practice.4 METHODS: We retrospectively evaluated outcomes for men diagnosed between 1/1/2013 - 5/31/2014 with NCCN very low, low and intermediate risk prostate cancer who selected AS in nine large community urology practices. We used univariate and multivariate analyses to describe associations between race, age, insurance status, family history, comorbidity, clinical stage, Gleason score, NCCN risk-group, and PSA density with discontinuation of AS.

548 men on AS were followed for a median of 3.35 years. 89% (492) continued to follow-up with diagnosing practice. 32% (171) discontinued AS. On multivariate analysis, increasing NCCN risk classification (HR 1.65, p=0.02 and HR 2.09, p<0.01 for low and intermediate risk vs. very low risk) was significantly associated with discontinuation. Among those who discontinued AS, surgery and radiation were utilized equally (47% and 53%, respectively, p=0.48).

In this community-based cohort of men on AS, a minority were lost to follow-up and adherence to AS was similar to other reports. Disease characteristics more than sociodemographic characteristics correlated with adherence to AS, while surgery and radiotherapy were utilized equally among those discontinuing AS, both suggesting guideline concordant practice of medicine.

Urology. 2019 Apr 25 [Epub ahead of print]

Jeremy B Shelton, Thomas A Paivanas, Phil Buffington, Stephen R Ruyle, Edward S Cohen, Richard Natale, Bryan Mehlhaff, Ronald Suh, Timothy J Bradford, Alec S Koo, Lorna Kwan, Neal Shore

UCLA, Urology, 17003 Wilshire Blvd, Los Angeles, California 91436, United States. Electronic address: ., CUSP Clinical Research Consortium. 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: ., Skyline Urology. Electronic address: ., UCLA, Urology, 17003 Wilshire Blvd, Los Angeles, California 91436, United States. Electronic address: ., Atlantic Urology Clinics. Electronic address: .