How Active is Active Surveillance? Intensity of Follow-Up During Active Surveillance for Prostate Cancer in the United States

While major prostate cancer active surveillance (AS) programs recommend repeat testing such as PSA and prostate biopsy, compliance with such testing is unknown. Our objective was to determine whether men in the community receive the same intensity of AS testing as in prospective AS protocols.

We performed a retrospective cohort study of men aged ≥66 in the SEER-Medicare database diagnosed with prostate cancer from 2001-2009 who did not receive curative therapy in the year after diagnosis with ≥1 post-diagnosis prostate biopsy. We used multivariable-adjusted Poisson regression to determine the association between frequency of AS testing with patient demographics and clinical features. Among 1349 men with ≤5 years follow-up, we determined the proportion undergoing testing of the intensity recommended by the Sunnybrook and PRIAS programs (≥14 PSA and ≥2 biopsy), and at Johns Hopkins (≥10 PSA and ≥4 biopsy).

Among 5192 patients undergoing AS, >80% had ≥1 PSA test per year but <13% received biopsy beyond the first 2 years. MRI was rarely used during the study period. On multivariable analysis, recent diagnosis and higher income were associated with higher frequency of surveillance biopsy, while older age and greater comorbidity were associated with fewer biopsies. African American men underwent fewer PSAs but similar numbers of biopsies. During 5 years of AS, only 11.1% and 5.0% met the testing standards of the Sunnybrook/PRIAS and Johns Hopkins programs.

In the community, very few elderly men receive the intensity of AS testing recommended by major prospective AS programs.; Key of Definition for Abbreviations: AS=active surveillance, PCa=prostate cancer, PSA=prostate specific antigen, MRI=magnetic resonance imaging, NCCN=National Comprehensive Cancer Network, PRIAS=Prostate Cancer Research International Active Surveillance, WW=watchful waiting.

The Journal of urology. 2016 Mar 02 [Epub ahead of print]

Stacy Loeb, Dawn Walter, Caitlin Curnyn, Heather T Gold, Herbert Lepor, Danil V Makarov

Department of Urology, New York University, NY, USA; Population Health, New York University, NY, USA; Laura & Isaac Perlmutter Cancer Center, New York University, NY, USA. Electronic address: ., Population Health, New York University, NY, USA., Population Health, New York University, NY, USA., Population Health, New York University, NY, USA., Department of Urology, New York University, NY, USA., Department of Urology, New York University, NY, USA; Population Health, New York University, NY, USA; Laura & Isaac Perlmutter Cancer Center, New York University, NY, USA.

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