Oncology - Prostate
Introduction & Objective :
Active surveillance (AS) is a recommended management strategy for men with low risk prostate cancer. Prior studies have shown significant variation in AS utilization among providers. We aimed to characterize factors associated with AS utilization among men with newly diagnosed prostate cancer in a regional collaborative.
We performed an analysis of the Pennsylvania Urologic Regional Collaborative (PURC), a voluntary collaborative of both private and academic urology practices in Southeastern Pennsylvania and New Jersey. We identified men with newly-diagnosed NCCN very-low, low, and intermediate risk prostate cancer, and determined the initial treatment modality used to manage these men. Multivariable logistic regression analysis was then used to identify factors associated with the use of active surveillance as initial management strategy.
A total of 1880 men with low and intermediate risk prostate cancer were identified from PURC. Table 1 shows patient demographics and initial management strategy, stratified by disease risk. Table 2 shows the results of a multivariable logistic regression analysis of factors associated with AS utilization. Patient age was inversely associated with the use of AS, whereas no significant associations were observed with race or family history. With the exception of clinical stage, more-advanced disease-specific parameters were strongly associated with a decreased utilization of AS.
Within PURC, AS was the most common initial treatment modality for men with NCCN very-low and low risk prostate cancer. Patient age and measures of disease risk (biopsy grade group, PSA, tumor volume on biopsy) were strongly associated with AS utilization. Studies of large collaborative datasets such as PURC may allow for a better understanding of the factors underlying practice and provider-level variation in AS utilization.