scholarly journals Variation in the Use of Active Surveillance for Low-Risk Prostate Cancer Across US Census Regions

2021 ◽  
Vol 11 ◽  
Author(s):  
Bashir Al Hussein Al Awamlh ◽  
Neal Patel ◽  
Xiaoyue Ma ◽  
Adam Calaway ◽  
Lee Ponsky ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Regional Differences ◽  
Multivariable Analysis ◽  
Low Risk ◽  
The West ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Us Census ◽  
The Impact

Substantial geographic variation in healthcare practices exist. Active surveillance (AS) has emerged as a critical tool in the management of men with low-risk prostate cancer. Whether there have been regional differences in adoption is largely unknown. The SEER “Prostate with Watchful Waiting Database” was used to identify patients diagnosed with localized low-risk prostate cancer and managed with AS across US census regions between 2010 and 2016. Multivariable logistic regression models were used to determine the impact of region on undergoing AS and factors associated with AS use within each US census region. Between 2010 and 2016, the proportion of men managed with AS increased from 20.8% to 55.9% in the West, 11.5% to 50.0% in Northeast, 9.9% to 43.4% in the South and 15.1% to 56.2% in Midwest (p < 0.0001). On multivariable analysis, as compared to the West, men in all regions were less likely to undergo AS (p < 0.001). Black men in the West (OR 1.36, 95%CI 1.25–1.49) and Midwest (OR 1.62, 95%CI 1.35–1.95) were more likely to undergo AS, but less likely in Northeast (OR 0.80, 95%CI 0.69–0.92). Men with higher socioeconomic status (SES) were more likely to undergo AS in the West (OR 1.47, 95%CI 1.39–1.55), Northeast (OR 1.57, 95%CI 1.36–1.81), and South (OR 1.24, 95%CI 1.13–1.37) but not in the Midwest (OR 0.85, 95%CI 0.73–0.98). We found striking regional differences in the uptake of AS according to race and SES. Geography must be taken into consideration when assessing barriers to AS use.

scholarly journals Perceived barriers to the adoption of active surveillance in low-risk prostate cancer: a qualitative analysis of community and academic urologists

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shellie D. Ellis ◽  
Soohyun Hwang ◽  
Emily Morrow ◽  
Kim S. Kimminau ◽  
Kelly Goonan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Practice Variation ◽  
Low Risk ◽  
Treatment Quality ◽  
Community Practice ◽  
Structured Interviews ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
The Impact

Abstract Background Clinical practice guidelines recommend active surveillance as the preferred treatment option for low-risk prostate cancer, but only a minority of eligible men receive active surveillance, and practice variation is substantial. The aim of this study is to describe barriers to urologists’ recommendation of active surveillance in low-risk prostate cancer and explore variation of barriers by setting. Methods We conducted semi-structured interviews among 22 practicing urologists, evenly distributed between academic and community practice. We coded barriers to active surveillance according to a conceptual model of determinants of treatment quality to identify potential opportunities for intervention. Results Community and academic urologists were generally in agreement on factors influencing active surveillance. Urologists perceived patient-level factors to have the greatest influence on recommendations, particularly tumor pathology, patient age, and judgements about the patient’s ability to adhere to follow-up protocols. They also noted cross-cutting clinical barriers, including concerns about the adequacy of biopsy samples, inconsistent protocols to guide active surveillance, and side effects of biopsy procedures. Urologists had differing opinions on the impact of environmental factors, such as financial disincentives and fear of litigation. Conclusions Despite national and international recommendations, both academic and community urologists note a variety of barriers to implementing active surveillance in low risk prostate cancer. These barriers will need to be specifically addressed in efforts to help urologists offer active surveillance more consistently.

scholarly journals Perceived barriers to the adoption of active surveillance in low-risk prostate cancer: A Qualitative Analysis of Community and Academic Urologists

2020 ◽  
Author(s):  
Shellie D Ellis ◽  
Soohyun Hwang ◽  
Emily Morrow ◽  
Kim S. Kimminau ◽  
Kelly Goonan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Practice Variation ◽  
Low Risk ◽  
Treatment Quality ◽  
Community Practice ◽  
Structured Interviews ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
The Impact

Abstract Background: Clinical practice guidelines recommend active surveillance as the preferred treatment option for low-risk prostate cancer, but only a minority of eligible men receive active surveillance, and practice variation is substantial. The aim of this study is to describe barriers to urologists’ recommendation of active surveillance in low-risk prostate cancer and explore variation of barriers by setting. Methods: We conducted semi-structured interviews among 22 practicing urologists, evenly distributed between academic and community practice. We coded barriers to active surveillance according to a conceptual model of determinants of treatment quality to identify potential opportunities for inResults: Community and academic urologists were generally in agreement on factors influencing active surveillance. Urologists perceived patient-level factors to have the greatest influence on recommendations, particularly tumor pathology, patient age, and judgements about the patient’s ability to adhere to follow-up protocols. They also noted cross-cutting clinical barriers, including concerns about the adequacy of biopsy samples, inconsistent protocols to guide active surveillance, and side effects of biopsy procedures. Urologists had differing opinions on the impact of environmental factors, such as financial disincentives and fear of litigation. Conclusions: Despite national and international recommendations, both academic and community urologists note a variety of barriers to implementing active surveillance in low risk prostate cancer. These barriers will need to be specifically addressed in efforts to help urologists offer active surveillance more consistently.

scholarly journals Persistent Barriers to the Adoption of Active Surveillance in Low-Risk Prostate Cancer: A Qualitative Analysis of Community and Academic Urologists

2020 ◽  
Author(s):  
Shellie D Ellis ◽  
Soohyun Hwang ◽  
Emily Morrow ◽  
Kim S. Kimminau ◽  
Kelly Goonan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Practice Variation ◽  
Low Risk ◽  
Treatment Quality ◽  
Community Practice ◽  
Structured Interviews ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
The Impact

Abstract Background Clinical practice guidelines recommend active surveillance as the preferred treatment option for low-risk prostate cancer, but only a minority of eligible men receive active surveillance, and practice variation is substantial. The aim of this study is to describe barriers to urologists’ recommendation of active surveillance in low-risk prostate cancer and explore variation of barriers by setting.Methods We conducted semi-structured interviews among 22 practicing urologists, evenly distributed between academic and community practice. We coded barriers to active surveillance according to a conceptual model of determinants of treatment quality to identify potential opportunities for intervention.Results Community and academic urologists were generally in agreement on factors influencing active surveillance. Urologists perceived patient-level factors to have the greatest influence on recommendations, particularly tumor pathology, patient age, and judgements about the patient’s ability to adhere to follow-up protocols. They also noted cross-cutting clinical barriers, including concerns about the adequacy of biopsy samples, inconsistent protocols to guide active surveillance, and side effects of biopsy procedures. Urologists had differing opinions on the impact of environmental factors, such as financial disincentives and fear of litigation.Conclusions Despite national and international recommendations, both academic and community urologists note a variety of barriers to implementing active surveillance in low risk prostate cancer. These barriers will need to be specifically addressed in efforts to help urologists offer active surveillance more consistently.Trial Registration: N/A

Incidence and predictors of upgrading and upstaging among 10,000 contemporary patients with low-risk prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 32-32
Author(s):  
Kathryn Tindell Dinh ◽  
Brandon Arvin Virgil Mahal ◽  
David R. Ziehr ◽  
Vinayak Muralidhar ◽  
Yu-Wei Chen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Significant Proportion ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Risk Patients

32 Background: To inform decisions about active surveillance, we determined the incidence of upgrading and upstaging for a contemporary cohort of low-risk prostate cancer patients who received radical prostatectomy and identified clinical predictors of advanced disease. Methods: We studied 10,273 patients in the Surveillance, Epidemiology, and End Result (SEER) database diagnosed with low-risk prostate cancer (cT1c-T2a, PSA<10 ng/mL and Gleason 3+3=6) in 2010-2011. Upgrading was defined as pathologic Gleason score 7-10 and upstaging as pathologic T3-T4/N1 disease. Regression coefficients were used to evaluate the predictive value of clinical factors for upgrading or upstaging. Significant factors were used to develop a risk stratification table to evaluate individual patients. Results: At prostatectomy, 44% of patients were upgraded and 9.7% were upstaged. Multivariable analysis showed age, PSA, and percent total cores positive were associated with advanced disease (all p<0.001). When these variables were dichotomized by the median, age >60 (Adjusted Odds Ratio [AOR] 1.39), PSA>5.0 (AOR 1.28), and >25% total cores positive (AOR 1.76) were significantly associated with upgrading (all p<0.001). Similarly, age>60 (AOR 1.42), PSA>5.0 (AOR 1.44), and >25% total cores positive (AOR 2.26) were associated with upstaging (all p<0.001). Sixty percent of low-risk patients with PSA 7.5-9.9 and >25% total cores positive were upgraded. Conclusions: A significant proportion of low-risk patients eligible for active surveillance were harboring more aggressive or locally-advanced prostate cancer. Age, PSA and percent total cores positive should be used to assess risk of upgrading or upstaging and can guide decisions to pursue further evaluation or treatment. [Table: see text]

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