Active Surveillance Follow-Up for Prostate Cancer Lacks Consistency

Only one in three men with prostate cancer received care in accordance with guidelines for active surveillance, according to a new study presented at the American Urological Association annual Meeting, held May 6–10 in San Diego. The use of active surveillance is increasing, but these results suggest quality improvement is needed.

“Although [active surveillance] for prostate cancer implies a plan to follow patients over time with repeated testing for disease progression, little is known about the rigor of such follow-up outside of specific academic protocols,” wrote study authors led by Gregory B. Auffenberg, MD, of the University of Michigan in Ann Arbor.

The study included 431 patients diagnosed with prostate cancer in the Michigan Urological Surgery Improvement Collaborative (MUSIC), a consortium of 42 practices with a prospective clinical registry.

All included patients selected active surveillance for primary management of prostate cancer, and remained on surveillance for at least 2 years. Patients had a median age at entry into active surveillance of 66.6 years, with a median PSA of 5.3 ng/mL. Most patients (75%) had a biopsy Gleason score ≤ 6, while 17% had Gleason 3 + 4 disease.

The follow-up testing was analyzed against the National Comprehensive Cancer Network guidelines for active surveillance. Those guidelines include at least three PSA tests in the 2 years following diagnosis, as well as at least one repeat biopsy.

In total, 30.6% of patients had follow-up PSA testing and prostate biopsy that matched those guidelines. Among the 69.4% of patients who were non-concordant with the guidelines, most (53.6% of the full cohort) did not have a repeat biopsy, and 16% underwent a biopsy but did not complete at least three PSA tests during the 2-year interval.

A small group of patients (4.2% of the full cohort) had neither a biopsy nor a single follow-up PSA test. Some patients had no biopsy but one PSA test (9%) or two PSA tests (9%), and a larger group had no biopsy but the recommended three or more PSA tests (31.3%).

In total, 1.4% of the cohort had a biopsy but no follow-up PSA test, 4.9% had a biopsy and one PSA test, and 9.5% had a biopsy and two PSA tests.

“While use of [active surveillance] is increasing, these findings highlight the need to better understand reasons for variation in follow-up testing and for quality improvement activities aimed at better implementation of this management strategy,” the authors concluded.