Use of Monitoring Tests Among Patients With Localized Prostate Cancer Managed With Observation

Abstract

Purpose:It is unknown whether compliance with recommended monitoring tests during observation of localized prostate cancer has changed over time.Materials and Methods:We performed a retrospective cohort study of Medicare beneficiaries diagnosed with low- or intermediate-risk prostate cancer in 2004-2016 who were initially managed with observation for a minimum of 12 months. The primary objective was to examine rates of PSA testing, prostate biopsy, and prostate MRI. We used multivariable mixed effects Poisson regression to determine whether rates of PSA testing and prostate biopsy increased over time. In addition, we identified clinical, sociodemographic, and provider factors associated with the frequency of monitoring tests during observation.Results:We identified 10,639 patients diagnosed at a median age of 73 (IQR 69-77) years. The median follow-up time was 4.3 (IQR 2.7-6.6) years after diagnosis. Among patients managed without treatment for 5 years, 98% received at ≥1 PSA test, 48.0% ≥1 additional prostate biopsy, and 31.0% ≥1 prostate MRI. Among patients managed with observation for ≥12 months, mixed effects Poisson regression revealed that rates of PSA testing and biopsy increased over time (per calendar year: RR 1.02, 95% CI: 1.02-1.03 and RR 1.10, 95% CI: 1.08-1.11, respectively). Clinical and sociodemographic factors including age, clinical risk, race/ethnicity, census tract poverty, and region were associated with rates of biopsy and PSA testing.Conclusions:Use of recommended monitoring tests including repeat prostate biopsy remains low among Medicare beneficiaries undergoing observation for low- and intermediate-risk prostate cancer.

This Month in Adult Urology

“…Leapman et al (page 710) present a retrospective cohort multicenter study of Medicare beneficiaries diagnosed between 2004 and 2016 and initially managed with observation for at least 12 months. 4 In those patients followed without treatment for at least 5 years, only 48% had any additional prostate biopsies and 31% had 1 prostate MRI. Accepting that patient preference and clinical factors including age and risk are central to the decisions around intensity of monitoring, some of the other observations from the authors point to ongoing sociodemographic disparities in the delivery of guideline-concordant care.…”

‘It Just Makes Sense to Me’: A qualitative study exploring patient decision‐making and experiences with prostate MRI during active surveillance for prostate cancer

“…3 Prostate MRI has been rapidly incorporated into clinical practice in multiple contexts, including prior to prostate biopsy, as a tool for local staging and as a component of active surveillance. 4,5 Although there is much information available regarding the diagnostic and prognostic accuracy of prostate MRI, little is known about patient experiences with and knowledge of MRI imaging and its role in their treatment decision-making. 6,7 Prior observational studies have found that use of prostate MRI is associated with increased use of initial observational management of prostate cancer.…”

National Trends in the Practice of Active Surveillance

“…In this issue of The Journal, Leapman and colleagues (page 710) sought to assess clinical trends in follow-up testing over the last 15 years. 4 Using Surveillance, Epidemiology, and End Results–Medicare data from 2004-2016, the authors identified patients diagnosed with low- or intermediate-risk prostate cancer who did not undergo treatment of their cancer within 12 months of diagnosis. This population was considered to be managed with observation, and the number of PSA tests and prostate biopsies performed during follow-up were assessed, along with demographic factors and socioeconomic status.…”