Poster, Podium & Video Sessions
Presentation Authors: Adam Reese*, Claudette Fonshell, Serge Ginzburg, Thomas Guzzo, Thomas Lanchoney, Bret Marlowe, Marc Smaldone, Edouard Trabulsi, Robert Uzzo, on behalf of the Pennsylvania Urologic Regional Collaborative, Philadelphia, PA
Introduction: Active surveillance (AS) is gaining increasing acceptance as an effective management strategy for men with low risk prostate cancer. We analyzed a regional prostate cancer collaborative in order to characterize variation in the utilization of AS among practitioners and identify factors influencing AS rates.
Methods: The Pennsylvania Urologic Regional Collaborative (PURC), established in 2014, is a voluntary collaborative of urology practices in Southeastern Pennsylvania focused on the evaluation and improvement of prostate cancer care. We prospectively identified men with newly diagnosed prostate cancer across 6 academic and private practice sites from PURC, and determined the percentage of men initially managed with AS. Variations in AS rates by individual practitioner were determined for men with NCCN very low or low risk disease. Demographic and clinicopathologic parameters were assessed to determine how these factors influenced AS rates.
Results: Between May 2015 and October 2016, 282 of 1154 (19.6%) men with newly diagnosed prostate cancer underwent AS as initial management strategy, including 82/104 (78.9%) men with NCCN very low and 133/322 (41.3%) with NCCN low risk disease. AS rates stratified by practitioner for men with very low or low risk disease ranged from 11.1% to 100% (Figure 1). Associations of demographic and clinicopathologic parameters with AS rates are shown in the Table. High PSA, Gleason score, clinical stage, and NCCN risk category were all strongly associated with decreased utilization of AS (all p-values < 0.01).
Conclusions: Recent data report AS rates as high as 91% and 74% for NCCN very low and low risk prostate cancer, respectively. In the PURC collaborative, we observed lower rates of AS utilization for men with low risk prostate cancer, and significant variation in AS utilization among practitioners. These findings demonstrate the potential importance of quality collaboratives such as PURC in helping to identify variations in care and targets for quality improvement within local markets.
Source Of Funding: Data was provided with permission from the Pennsylvania Urologic Regional Collaborative (PURC), funded by participating urology practices and the Partnership for Patient Care, a quality improvement initiative supported by the Health Care Improvement Found