Oncology - Prostate
Introduction & Objective :
A major paradigm shift in the PSA-based approach to prostate cancer screening has led to the development of a number of prostate cancer biomarkers designed to supplement PSA-based screening approaches. Numerous prostate cancer biomarkers have overlapping indications and are marketed heavily, but to date there is little data regarding their utilization. We review practice patterns for prostate cancer biomarker utilization in a large statewide quality registry with a focus on the extent of heterogeneity across practices and providers.
The Pennsylvania Urologic Regional Collaborative (PURC) is a voluntary collaborative of urology practices in Pennsylvania and New Jersey focused on evaluation and improvement of prostate cancer care. Established in 2015, 9 participating practices encompassing 88 physicians have accrued over 5,600 patients into the registry. We identified all men whom underwent prostate cancer biomarker testing, and report utilization patterns. Additionally, a survey regarding biomarker use was administered to all practitioners within the collaborative.
260 (17.9%) men underwent prostate cancer biomarker testing. Biomarker testing was most commonly performed in men with NCCN low and intermediate-risk disease (28.6% and 39.1%, respectively). When stratified by treatment type, biomarker testing was most common among patients whose primary treatment was active surveillance (52.2%). There was significant variation in genomic testing by practice and within each practice site (Fig 1).
The survey response rate was 29.5%. 84.2% of respondents utilize biomarkers in their prostate cancer patients; doubts regarding clinical efficacy was the number one reason cited for not using biomarkers. When posed with a hypothetical clinical scenario, 25% of respondents selected a non-indicated biomarker.
Within a large prostate cancer quality collaborative, we identified significant variation in prostate cancer biomarker utilization by practice and provider. Understanding practice-level biomarker testing trends may identify targets for quality improvement and enhance appropriate test utilization.