PURPOSE: We used data from the Michigan Urological Surgery Improvement Collaborative (MUSIC) to evaluate the performance of published selection criteria for active surveillance (AS) in diverse urology practice settings.
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MATERIALS AND METHODS: For several AS guidelines, we calculated the proportion of men meeting each set of selection criteria that actually entered AS (defined as the sensitivity of the guideline). After identifying the most sensitive guideline for the entire cohort, we compared demographic and tumor characteristics between patients meeting this guideline who entered AS and those who received initial definitive therapy.
RESULTS: Among 4,882 men with newly diagnosed prostate cancer, 18% underwent AS. When applied to the entire cohort, the sensitivity of published guidelines ranged from 49% (Toronto) to 62% (Johns Hopkins, JH). At a practice-level, the sensitivity of the JH criteria varied widely from 27% to 84% (p< 0.001). Compared with men undergoing AS, patients meeting JH criteria that received definitive therapy were younger (p< 0.001), more likely to have a positive family history (p=0.003), a lower PSA (p< 0.001), greater number of positive cores (2 vs 1) on biopsy (p< 0.001), and higher cancer volume in the positive core(s)(p=0.002).
CONCLUSIONS: The sensitivity of published AS selection criteria varies widely across diverse urology practices. Among patients meeting the most stringent criteria, those who received initial definitive therapy had characteristics suggesting greater cancer risk, underscoring the nuanced clinical factors that influence treatment decisions.
Hawken SR, Womble PR, Herrel LA, Ye Z, Linsell SM, Hurley PM, Montie JE, Miller DC. Are you the author?
Department of Urology, University of Michigan, Ann Arbor, MI; Providence Hospital, Southfield, MI.
Reference: J Urol. 2015 May 13. pii: S0022-5347(15)03942-7.