Presentation Authors: Adam Reese*, Sitha Dy, Bret Marlowe, Claudette Fonshell, Philadelphia, PA, John Danella, Danville, PA, Serge Ginzburg, Philaldelphia, PA, Thomas Guzzo, Philadelphia, PA, Thomas Lanchoney, Bryn Mawr, PA, Jay Raman, Hershey, PA, Jeffrey Tomaszewski, Camden, NJ, Edouard Trabulsi, Marc Smaldone, Robert Uzzo, Philadelphia, PA
Introduction: Several prior studies have shown widespread variation in the utilization of active surveillance (AS) amongst individual physicians managing patients with newly diagnosed low risk prostate cancer. We hypothesized that factors including physician age and number of years in practice, as well as the volume of patients managed by the physician, may influence AS rates.
Methods: We analyzed the Pennsylvania Urologic Regional Collaborative (PURC), a voluntary collaborative of urology practices in Pennsylvania and New Jersey, including men with low risk prostate cancer as defined by the AUA. For each physician in PURC, we determined the percentage of low risk patients managed with AS. Using the Pearson correlation coefficient, we then determined associations of physician age, number of years in practice, and patient volume with AS utilization rates for each physician.
Results: AS rates by individual physician ranged from 10%-100% for men with low-risk prostate cancer, and 20%-100% for men with very low risk disease. Scatter plots of physician age, number of years in training, and patient volume vs. AS rate are shown in the Figure. Trends were seen towards decreased use of AS with increasing physician age, number of years in practice, and patient volume, although these associations did not reach statistical significance (see Table).
Conclusions: For patients with low risk prostate cancer, physician-related factors may impact adoption of AS. Specifically, we observed trends toward a decreased use of AS among physicians of older age, with a greater number of years in practice, and large patients volumes. These variables, however, explain only a small percentage of the significant variation in AS rates among individual practitioners. Additional study is therefore needed to better characterize the factors underlying AS variation and enable the delivery of AS in a more uniform and systematic fashion.
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 Foundation, Independence Blue Cross, and Southeastern PA hospitals and health systems.