Biopsy

Prostate cancer

Watchful waiting

Guideline

Prostate biopsy

Urology

Prostate-specific antigen

Concordance

Internal medicine

Prostate

Gynecology

Medicine

General surgery

Cancer

Pathology

The Journal of Urology

No AccessJournal of UrologyAdult Urology1 Mar 2017Variation in Guideline Concordant Active Surveillance Followup in Diverse Urology Practices Amy N. Luckenbaugh, Gregory B. Auffenberg, Scott R. Hawken, Apoorv Dhir, Susan Linsell, Sanjeev Kaul, David C. Miller, and Michigan Urological Surgery Improvement Collaborative Amy N. LuckenbaughAmy N. Luckenbaugh Equal study contribution. More articles by this author , Gregory B. AuffenbergGregory B. Auffenberg Equal study contribution. More articles by this author , Scott R. HawkenScott R. Hawken More articles by this author , Apoorv DhirApoorv Dhir More articles by this author , Susan LinsellSusan Linsell More articles by this author , Sanjeev KaulSanjeev Kaul More articles by this author , David C. MillerDavid C. Miller More articles by this author , and Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.09.071AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We examined the frequency of followup prostate specific antigen testing and prostate biopsy among men treated with active surveillance in the academic and community urology practices comprising MUSIC (Michigan Urological Surgery Improvement Collaborative). Materials and Methods: MUSIC is a consortium of 42 practices that maintains a prospective clinical registry with validated clinical data on all patients diagnosed with prostate cancer at participating sites. We identified all patients in MUSIC practices who entered active surveillance and had at least 2 years of continuous followup. After determining the frequency of repeat prostate specific antigen testing and prostate biopsy, we calculated rates of concordance with NCCN Guidelines® recommendations (ie at least 3 prostate specific antigen tests and 1 surveillance biopsy) collaborative-wide and across individual practices. Results: We identified 513 patients who entered active surveillance from January 2012 through September 2013 and had at least 2 years of followup. Among the 431 men (84%) who remained on active surveillance for 2 years 132 (30.6%) underwent followup surveillance testing at a frequency that was concordant with NCCN® (National Comprehensive Cancer Network®) recommendations. At the practice level, the median rate of guideline concordant followup was 26.5% (range 10% to 67.5%, p <0.001). Among patients with discordant followup, the absence of followup biopsy was common and not significantly different across practices (median rate 82.0%, p = 0.35). Conclusions: Among diverse community and academic practices in Michigan, there is wide variation in the proportion of men on active surveillance who meet guideline recommendations for followup prostate specific antigen testing and repeat biopsy. These data highlight the need for standardized active surveillance pathways that emphasize the role of repeat surveillance biopsies. References 1 : Factors influencing selection of active surveillance for localized prostate cancer. Urology2015; 86: 901. Google Scholar 2 : Trends in management for patients with localized prostate cancer, 1990-2013. JAMA2015; 314: 80. Google Scholar 3 : Population based study of use and determinants of active surveillance and watchful waiting for low and intermediate risk prostate cancer. J Urol2013; 190: 1742. Link, Google Scholar 4 : Contemporary use of initial active surveillance among men in Michigan with low-risk prostate cancer. Eur Urol2015; 67: 44. 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Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byRadhakrishnan A, Wallner L, Skolarus T, George A, Rosenberg B, Abrahamse P and Hawley S (2022) Exploring Variation in the Receipt of Recommended Active Surveillance for Men with Favorable-Risk Prostate CancerJournal of Urology, VOL. 208, NO. 3, (600-608), Online publication date: 1-Sep-2022.Gaylis F, Cooperberg M, Loeb S, Chen R, Seibert T, Cohen E, Dato P, Emeka A, Prime R, Romo S and Catalona W (2022) Conservative Management of Low-Risk Prostate Cancer: A Path to Value-Based CareUrology Practice, VOL. 9, NO. 3, (195-197), Online publication date: 1-May-2022.Waisman Malaret A, Chang P, Newcomb L, Faino A, Zheng Y, Zhu K, McKenney J, Brooks J, Dash A, Ellis W, Filson C, Gleave M, Liss M, Martin F, Morgan T, Carroll P, Nelson P, Lin D and Wagner A (2021) Effect of Diagnostic Biopsy Practice Location on Grade/Volume Reclassification in Active Surveillance for Prostate Cancer: A Multicenter Analysis from the Canary PASS CohortUrology Practice, VOL. 8, NO. 5, (576-582), Online publication date: 1-Sep-2021.Radhakrishnan A, Wallner L, Skolarus T, Shahinian V, Abrahamse P, Fetters M and Hawley S (2021) Primary Care Physician Perspectives on Low Risk Prostate Cancer Management: Results of a National SurveyUrology Practice, VOL. 8, NO. 4, (515-522), Online publication date: 1-Jul-2021.Detsky J, Ghiam A, Mamedov A, Commisso K, Commisso A, Zhang L, Liu S, Klotz L, Loblaw A and Vesprini D (2020) Impact of Biopsy Compliance on Outcomes for Patients on Active Surveillance for Prostate CancerJournal of Urology, VOL. 204, NO. 5, (934-940), Online publication date: 1-Nov-2020.Chu D, Liu T, Patel P, Routh J, Ouyang L, Baum M, Cheng E, Yerkes E and Isakova T (2020) Kidney Function Surveillance in the National Spina Bifida Patient Registry: A Retrospective Cohort StudyJournal of Urology, VOL. 204, NO. 3, (578-586), Online publication date: 1-Sep-2020.Taneja S (2019) Re: Reasons for Discontinuing Active Surveillance: Assessment of 21 Centres in 12 Countries in the Movember GAP3 ConsortiumJournal of Urology, VOL. 203, NO. 2, (252-253), Online publication date: 1-Feb-2020.Auffenberg G, Lane B, Linsell S, Brachulis A, Ye Z, Rakic N, Montie J, Miller D and Cher M (2017) A Roadmap for Improving the Management of Favorable Risk Prostate CancerJournal of Urology, VOL. 198, NO. 6, (1220-1222), Online publication date: 1-Dec-2017.Penson D (2016) Re: Urologist-Level Correlation in the Use of Observation for Low- and High-Risk Prostate CancerJournal of Urology, VOL. 197, NO. 2, (401-402), Online publication date: 1-Feb-2017. Volume 197Issue 3 Part 1March 2017Page: 621-626Supplementary Materials Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmsquality improvementprostate-specific antigenwatchful waitingbiopsyAcknowledgmentsDr. David Share, Tom Leyden, Rozanne Darland and Karlie Witbrodt, Blue Cross Blue Shield of Michigan, assisted with the study.MetricsAuthor Information Amy N. Luckenbaugh Equal study contribution. More articles by this author Gregory B. Auffenberg Equal study contribution. More articles by this author Scott R. Hawken More articles by this author Apoorv Dhir More articles by this author Susan Linsell More articles by this author Sanjeev Kaul More articles by this author David C. Miller More articles by this author Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

Variation in Guideline Concordant Active Surveillance Followup in Diverse Urology Practices