Factors Influencing Selection of Active Surveillance for Localized Prostate Cancer.

To determine how well demographic and clinical factors predict the initiation of Active Surveillance (AS).

AS has been suggested as a way to diminish overtreatment of men with prostate cancer; however, factors associated with the decision to choose AS are poorly quantified.

Using the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry we identified 2,977 men with prostate cancer who made treatment decisions from January 1, 2012 through December 31, 2013. We used chi-square and Wilcoxon tests to examine the association between factors and initiation of AS. Logistic Regression models were fit for D'Amico risk categories. Measures of model discrimination and calibration were estimated including area-under-the-curve (AUC) and Brier score (BS).

Patient age, Gleason score (GS), clinical T-stage, urology practice, and tumor volume (greatest percent of a core involved with cancer (GPC) and proportion of positive cores) were associated with the decision in the intermediate-risk cohort (AUC = 0. 875, BS = 0. 07) and the complete cohort (AUC = 0. 89, BS = 0. 10). Patient age, urology practice, and tumor volume were significant in the low-risk cohort (AUC = 0. 71, BS = 0. 22). The addition of urology practice increased AUC in the low risk cohort from 0. 71 to 0. 76 and reduced BS score from 0. 22 to 0. 21.

The urology practice at which a patient is seen is an important predictor for whether patients will initiate AS. Predictions were least accurate for low-risk patients suggesting factors such as patient preference, play a role in treatment decisions.

Urology. 2015 Sep 07 [Epub ahead of print]

Jianyu Liu, Paul R Womble, Selin Merdan, David C Miller, James E Montie, Brian T Denton, Michigan Urological Surgery Improvement Collaborative

Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, 48109, USA. , Department of Urology, University of Michigan, Ann Arbor, MI, 48109, USA. , Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, 48109, USA. , Department of Urology, University of Michigan, Ann Arbor, MI, 48109, USA. , Department of Urology, University of Michigan, Ann Arbor, MI, 48109, USA. , Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Urology, University of Michigan, Ann Arbor, MI, 48109, USA. 

PubMed