Variation in Guideline Concordant Active Surveillance Follow-up in Diverse Urology Practices

We examined the frequency of follow-up prostate-specific antigen (PSA) testing and prostate biopsy among men managed with active surveillance (AS) in academic and community urology practices comprising the Michigan Urological Surgery Improvement Collaborative (MUSIC).

MUSIC is a consortium of 42 practices that maintains a prospective clinical registry with validated clinical data for all patients diagnosed with prostate cancer at participating sites. We identified all patients in MUSIC practices who entered AS and had at least two years of continuous follow-up. After determining the frequency of repeat PSA testing and prostate biopsy, we calculated rates of concordance with NCCN guideline recommendations (i.e., at least three PSA tests and one surveillance biopsy) both collaborative-wide and across individual practices.

We identified 513 patients entering AS from 1/2012-9/2013 with at least two years of follow-up. Among the 431 men (84%) that remained on AS for two years, 132 (30.6%) had follow-up surveillance testing at a frequency that was concordant with NCCN recommendations. At a practice-level, the median rate of guideline concordant follow-up was 26.5% (range 10-67.5%, p<0.001). Among patients with discordant follow-up, the absence of follow-up biopsy was common and not significantly different across practices (median rate=82.0%, p=0.35).

Among diverse community and academic practices in Michigan, there is wide variation in the proportion of men on active surveillance that meet guideline recommendations for follow-up PSA testing and repeat biopsy. These data highlight the need for standardized AS pathways that emphasize the role for repeat surveillance biopsies.

The Journal of urology. 2016 Sep 20 [Epub ahead of print]

Amy N Luckenbaugh, Gregory B Auffenberg, Scott R Hawken, Apoorv Dhir, Susan Linsell, Sanjeev Kaul, David C Miller, Michigan Urological Surgery Improvement Collaborative

Department of Urology, University of Michigan, Ann Arbor, Michigan., Comprehensive Urology, William Beaumont Hospital, Royal Oak, Michigan., Department of Urology, University of Michigan, Ann Arbor, Michigan. Electronic address: .