Jeremy B Shelton1, Phil Buffington2, Richard Augspurger3, Franklin Gaylis4, Todd Cohen5, Bryan Mehlhaff6, Ronald Suh7, Timothy J Bradford8, Lorna Kwan9, Alec S Koo10, Neal Shore11. 1. Department of Urology, UCLA, Los Angeles, CA. Electronic address: jshelton@mednet.ucla.edu. 2. Urology Group, Cincinnati, OH. 3. Urology Center of Colorado, Denver, CO. 4. Genesis Healthcare Partners, San Diego, CA. 5. Carolina Urology Partners, Charlotte, NC. 6. Oregon Urology Institute, Springfield, OR. 7. Urology of Indiana, Indianapolis, IN. 8. Virginia Urology, VA. 9. Department of Urology, UCLA, Los Angeles, CA; Urology Group, Cincinnati, OH; Urology Center of Colorado, Denver, CO; Genesis Healthcare Partners, San Diego, CA; Carolina Urology Partners, Charlotte, NC; Oregon Urology Institute, Springfield, OR; Urology of Indiana, Indianapolis, IN; Virginia Urology, VA; Department of Urology, UCLA, the Skyline Urology, Los Angeles, CA; Atlantic Urology Clinics, Myrtle Beach, SC. 10. Department of Urology, UCLA, the Skyline Urology, Los Angeles, CA. 11. Atlantic Urology Clinics, Myrtle Beach, SC.
Abstract
OBJECTIVE: To characterize the contemporary management of prostate cancer patients in large community practices. The optimal management of incident prostate cancer has changed in the last decades to include active surveillance for a large number of men. At the same time, many community practices have merged into larger groups. The adoption of evidence-based guidelines is of increasing importance, but poorly understood in this newer practice setting. METHODS: We conducted a retrospective chart review of men ≤75 years old with very low, low, and intermediate risk incident prostate cancer diagnosed between December 1, 2012 and March 31, 2014, in 9 geographically distributed large urology practices. We used descriptive statistics and multivariable regression to assess predictors of primary management choice. RESULTS: 2029 men were in the study cohort. A majority were white (68.7%). Total of 45.7% had intermediate risk, 36.2% low risk, and 17.9% had very low risk disease cancer. Active surveillance (AS) was the initial treatment for 74.7% of men with very low risk disease, 43.5% of men with low risk disease and 10.8% of men with intermediate risk disease. The probability of choosing surgery vs radiation for men with lower and intermediate risk disease was 0.54 (95% confidence interval: 0.42, 0.65) and 0.59 (95% confidence interval: 0.48, 0.69), respectively. CONCLUSION: We found that the initial management of lower risk prostate cancer in large community urology practices largely followed clinical characteristics, widespread adoption of active surveillance, and equal use of surgery and radiation. However, some variation by practice suggested a need for further investigation and continued improvement. Published by Elsevier Inc.
OBJECTIVE: To characterize the contemporary management of prostate cancerpatients in large community practices. The optimal management of incident prostate cancer has changed in the last decades to include active surveillance for a large number of men. At the same time, many community practices have merged into larger groups. The adoption of evidence-based guidelines is of increasing importance, but poorly understood in this newer practice setting. METHODS: We conducted a retrospective chart review of men ≤75 years old with very low, low, and intermediate risk incident prostate cancer diagnosed between December 1, 2012 and March 31, 2014, in 9 geographically distributed large urology practices. We used descriptive statistics and multivariable regression to assess predictors of primary management choice. RESULTS: 2029 men were in the study cohort. A majority were white (68.7%). Total of 45.7% had intermediate risk, 36.2% low risk, and 17.9% had very low risk disease cancer. Active surveillance (AS) was the initial treatment for 74.7% of men with very low risk disease, 43.5% of men with low risk disease and 10.8% of men with intermediate risk disease. The probability of choosing surgery vs radiation for men with lower and intermediate risk disease was 0.54 (95% confidence interval: 0.42, 0.65) and 0.59 (95% confidence interval: 0.48, 0.69), respectively. CONCLUSION: We found that the initial management of lower risk prostate cancer in large community urology practices largely followed clinical characteristics, widespread adoption of active surveillance, and equal use of surgery and radiation. However, some variation by practice suggested a need for further investigation and continued improvement. Published by Elsevier Inc.