Appropriateness Criteria for Active Surveillance of Prostate Cancer.

Adoption of active surveillance (AS) is widely variable across urological communities. This suggests a need for more consistency in the counseling of patients. To address this need, we used the RAND/UCLA Appropriateness Method to develop appropriateness criteria and counseling statements for AS.

Panelists were recruited from Michigan Urological Surgery Improvement Collaborative (MUSIC) urology practices. Combinations of parameters thought to influence decision-making were used to create and score 160 theoretical clinical scenarios for appropriateness of AS. Recent rates of AS among real patients across the state were assessed using the MUSIC registry.

Low volume Gleason 6 was deemed "highly appropriate" for AS, whereas high volume Gleason 6 and low volume Gleason 3+4 were deemed "appropriate" to "uncertain." No scenario was deemed "inappropriate" or "highly inappropriate." Prostate specific antigen density, race, and life expectancy (LE) impacted scores for intermediate and high volume Gleason 6 and low volume Gleason 3+4. The greatest degree of score dispersion (disagreement) occurred in scenarios with long LE, high volume Gleason 6, and low volume Gleason 3+4. Recent rates of AS utilization among real patients ranged from 0% to 100% at the provider level for low or intermediate biopsy volume Gleason 6 demonstrating a clear opportunity for quality improvement.

By virtue of this work, urologists have the opportunity to present specific recommendations from the panel to their individual patients. Community-wide efforts aimed at raising rates of AS and reducing practice- and physician-level variation in the choice of AS versus treatment are warranted.

The Journal of urology. 2016 Jul 12 [Epub ahead of print]

Michael L Cher, Apoorv Dhir, Gregory B Auffenberg, Susan Linsell, Yuqing Gao, Bradley Rosenberg, S Mohammad Jafri, Laurence Klotz, David C Miller, Khurshid R Ghani, Steven J Bernstein, James E Montie, Brian R Lane, Michigan Urological Surgery Improvement Collaborative

Department of Urology, Wayne State University, Detroit, MI. Electronic address: ., Department of Urology, University of Michigan, Ann Arbor, MI., Department of Urology, University of Michigan, Ann Arbor, MI., Department of Urology, University of Michigan, Ann Arbor, MI., Department of Urology, University of Michigan, Ann Arbor, MI., Comprehensive Urology, Royal Oak, MI., Comprehensive Urology, Royal Oak, MI., Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada., Department of Urology, University of Michigan, Ann Arbor, MI., Department of Urology, University of Michigan, Ann Arbor, MI., Department of Medicine, University of Michigan, Ann Arbor, MI; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI., Department of Urology, University of Michigan, Ann Arbor, MI., Division of Urology, Spectrum Health, Grand Rapids, MI.

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