It is unknown whether compliance with recommended monitoring tests during observation of localized prostate cancer has changed over time.
We performed a retrospective cohort study of Medicare beneficiaries diagnosed with low- or intermediate-risk prostate cancer in 2004-2016 who were initially managed with observation for a minimum of 12 months. The primary objective was to examine rates of PSA testing, prostate biopsy, and prostate MRI. We used multivariable mixed effects Poisson regression to determine whether rates of PSA testing and prostate biopsy increased over time. In addition, we identified clinical, sociodemographic, and provider factors associated with the frequency of monitoring tests during observation.
We identified 10,639 patients diagnosed at a median age of 73 (IQR 69-77) years. The median follow-up time was 4.3 (IQR 2.7-6.6) years after diagnosis. Among patients managed without treatment for 5 years, 98% received at ≥1 PSA test, 48.0% ≥1 additional prostate biopsy, and 31.0% ≥1 prostate MRI. Among patients managed with observation for ≥12 months, mixed effects Poisson regression revealed that rates of PSA testing and biopsy increased over time (per calendar year: RR 1.02, 95% CI: 1.02-1.03 and RR 1.10, 95% CI: 1.08-1.11, respectively). Clinical and sociodemographic factors including age, clinical risk, race/ethnicity, census tract poverty, and region were associated with rates of biopsy and PSA testing.
Use of recommended monitoring tests including repeat prostate biopsy remains low among Medicare beneficiaries undergoing observation for low and intermediate-risk prostate cancer.
The Journal of urology. 2023 Feb 08 [Epub ahead of print]
Michael S Leapman, Rong Wang, Stacy Loeb, Tyler M Seibert, Franklin D Gaylis, Ben Lowentritt, Gordon A Brown, Ronald Chen, Daniel Lin, John Witte, Matthew R Cooperberg, William J Catalona, Cary P Gross, Xiaomei Ma
Department of Urology, Yale School of Medicine, New Haven, Connecticut., Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut., Departments of Urology and Population Health, New York University Langone Health., Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California., Genesis Healthcare, San Diego, California., Chesapeake Urology, Baltimore, Maryland., New Jersey Urology, Bloomfield, New Jersey., Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas., Department of Urology, University of Washington, Seattle, Washington., Department of Epidemiology and Population Health, Stanford University., Department of Urology, University of California San Francisco, San Francisco, California., Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.