Format

Send to

Choose Destination
Urology. 2018 Aug;118:127-133. doi: 10.1016/j.urology.2018.04.038. Epub 2018 May 21.

Association Between Early Confirmatory Testing and the Adoption of Active Surveillance for Men With Favorable-risk Prostate Cancer.

Author information

1
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: kayed@med.umich.edu.
2
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
3
Department of Urology, University of Michigan, Ann Arbor, MI.
4
Spectrum Health Urology, Grand Rapids, MI.
5
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Department of Urology, University of Michigan, Ann Arbor, MI.
6
Department of Urology, Wayne State University, Detroit, MI.

Abstract

OBJECTIVE:

To examine the relationship between the use and results of early confirmatory testing and persistence on active surveillance (AS).

METHODS:

We identified all men in the Michigan Urological Surgery Improvement Collaborative registry diagnosed with favorable-risk prostate cancer from June 2016 to June 2017. We next examined trends in the use of early confirmatory test(s), defined as repeat biopsy, prostate magnetic resonance imaging, or molecular classifiers obtained within 6 months of the initial cancer diagnosis, in patients with favorable-risk prostate cancer. We then compared the proportion of men remaining on AS 6 months after diagnosis according to reassuring vs nonreassuring results, also stratifying by age and Gleason score.

RESULTS:

Among 2529 patients, 32.7% underwent early confirmatory testing within 6 months of diagnosis. Its use increased from 25.4% in the second quarter of 2016 to 34.9% in the second quarter of 2017 (P = .025). Molecular classifiers were most frequently used (55%), followed by magnetic resonance imaging (34%) and repeat biopsy (11%). Sixty-four percent (n = 523) had a reassuring result. Rates of AS were higher for patients with early reassuring results; 82% remained on AS (n = 427) compared to 52% (n = 157) of those with nonreassuring results and 51% (n = 873) with no early confirmatory testing (P <.001).

CONCLUSION:

Rates of AS are higher among men with early reassuring results, supporting the clinical utility of these tests. Nonetheless, high rates of AS among patients with nonreassuring results underscore the complexity of shared decision-making in this setting.

Comment in

PMID:
29792972
DOI:
10.1016/j.urology.2018.04.038
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center