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JU INSIGHT Many Men with Favorable-Risk Prostate Cancer on Active Surveillance Are, in Fact, Not Being Actively Surveilled

By: Archana Radhakrishnan, MD, MHS; Lauren P. Wallner, PhD, MPH; Ted A. Skolarus, MD, MPH; Arvin K. George, MD; Bradley H. Rosenberg, MD; Paul Abrahamse, MA; Sarah T. Hawley, PhD, MPH | Posted on: 01 Sep 2022

Radhakrishnan A, Wallner LP, Skolarus TA. Exploring variation in the receipt of recommended active surveillance for men with favorable-risk prostate cancer. J Urol. 2022; 208(3):600-608.

Study Need and Importance

Reasons explaining why men on active surveillance (AS) for favorable-risk prostate cancer do not receive all recommended surveillance testing are poorly understood. We leveraged a statewide registry of men with favorable-risk prostate cancer in Michigan to 1) describe contemporary trends in receipt of surveillance testing and 2) examine the influence of provider (urologist and primary care provider [PCP]) and patient factors on variation in receipt of recommended surveillance.

“Recognizing the influence of urologists on receipt of recommended testing, it will be important to support urologists through resources at the point of care delivery and integrated into routine clinical flow.”

What We Found

We examined receipt of recommended surveillance testing among 246 men with favorable-risk prostate cancer. We defined receipt based on the Michigan Urological Surgery Improvement Collaborative’s (MUSIC) low-intensity criteria, which include annual prostate specific antigen testing, and prostate biopsy or magnetic resonance imaging every 3 years. During 3 years of AS, just over half of men (56.5%) received all recommended surveillance testing (69.9% annual prostate specific antigen testing, 72.8% magnetic resonance imaging/biopsy; see Figure). We found that a substantial amount (19%) of the variation in receipt was attributed to individual urologists. We did not find significant associations between provider visits to either the urologist or PCP and receipt.

Figure. Distribution of receipt of recommended surveillance testing.

Limitations

MUSIC as a quality improvement collaborative only includes urology practices in the state of Michigan, which may limit generalizability. We also did not assess downstream outcomes related to not receiving the recommended testing due to limited availability of data for followup. Given that AS as a management strategy requires followup testing to be effective, this will be an important next step for future studies.

“We found that a substantial amount (19%) of the variation in receipt was attributed to individual urologists.”
“Receipt of surveillance testing meeting MUSIC’s low-intensity criteria among men with favorable-risk prostate cancer was suboptimal.”

Interpretation for Patient Care

Receipt of surveillance testing meeting MUSIC’s low-intensity criteria among men with favorable-risk prostate cancer was suboptimal. Recognizing the influence of urologists on receipt of recommended testing, it will be important to support urologists through resources at the point of care delivery and integrated into routine clinical flow. Additionally, PCPs may be an underutilized resource for improving adherence to surveillance protocols. Exploring how to leverage visits with PCPs to positively influence receipt appears warranted.

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