Adherence to Active Surveillance in Patients with Localized Prostate Cancer

April 6, 2017

Adherence to Active Surveillance in Patients with Localized Prostate Cancer

  1. Allan S. Brett, MD

Only 31% of cases were guideline-concordant, but whether limited adherence affects clinical outcomes is unclear.

  1. Allan S. Brett, MD

Active surveillance, an initial option for patients with low-risk localized prostate cancer, generally consists of periodic prostate-specific antigen (PSA) testing and repeated prostate biopsies; surgery or radiation therapy are offered if those tests suggest local progression or initial understaging.

In this study, researchers examined active surveillance practices using data from a Michigan urology consortium that includes 85% of the state's urologists. Specifically, the investigators assessed concordance with National Comprehensive Cancer Network guidelines, which recommend PSA testing “at least as often as every 6 months,” and repeat biopsies “as often as annually.” Cases were considered guideline-concordant if at least three PSA tests and one biopsy were performed during the first 2 years of active surveillance. Among 431 cases, the following outcomes occurred:

  • 31% were guideline-concordant

  • 31% were concordant for PSA testing but not biopsy

  • 16% were concordant for biopsy but not PSA testing

  • 22% were discordant for both PSA testing and biopsy

Comment

The authors express concern that failure to adhere to these guidelines “may increase the risk of unfavorable cancer related outcomes,” but they admit that varying intensities of active surveillance have not been compared adequately. Notably, in the recent ProtecT study (a comparison of AS, surgery, and radiotherapy), active surveillance consisted of serial PSA testing without repeated biopsies; 10-year mortality was virtually identical in the three groups, although the active surveillance group had slightly higher risk for developing metastases (NEJM JW Gen Med Nov 1 2016 and N Engl J Med 2016; 375:1415, 1425).

Editor Disclosures at Time of Publication

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

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