Active surveillance follow-up for prostate cancer: From guidelines to real-world clinical practice
Recommended Citation
Chiarelli G, Cirulli GO, Finati M, Stephens A, Tinsley S, Butaney M, Arora S, Sood A, Carrieri G, Briganti A, Montorsi F, Lughezzani G, Buffi NM, Rogers CG, Abdollah F. Active surveillance follow-up for prostate cancer: From guidelines to real-world clinical practice. Eur Urol 2024; 85:S1869-S1869.
Document Type
Conference Proceeding
Publication Date
3-1-2024
Publication Title
Eur Urol
Abstract
Introduction & Objectives: In the management of patients on active surveillance (AS) for prostate cancer (PCa), the major guidelines including the European Association of Urology (EAU), American Urological Association (AUA), and National Comprehensive Cancer Network (NCCN), slightly vary for monitoring recommendations, but all emphasize the importance of regular follow-up. EAU advises at least two PSA tests and one DRE annually, with a re-biopsy at least once every three years for a decade. Conversely, AUA and NCCN both recommend up to two PSA tests and one DRE yearly. AUA advises re-biopsies ranging from every one to four years, while NCCN proposes at least biennially, not surpassing once a year. Our study aimed to assess AS adherence in a “real-world” clinical practice. Materials & Methods: We utilized our institutional database which was built by interrogating our electronic medical records for all men who got diagnosed with PCa within Henry Ford Health. Our cohort included all patients aged < 76 years, who had a diagnosis of PCa Gleason Grade (GG) 1 or 2, with clinical tumor stage ≤cT2b, with PSA≤20 ng/ml, enrolled on AS following a diagnosis before 2022. This allows one year's time worth of eventual treatment information in our database. Median and Interquartile Range (IQR) were used to represent continuous variables, while frequencies and percentages were used for categorical variables. Cumulative incidence was used to depict PCSM. Results: A total of 1214 men met the inclusion criteria, of whom 722 (59%) were low-risk PCa and 492 (41%) intermediate-risk, according to the D'amico risk score, with a median age at diagnosis of 65 (IQR 60-70). Median PSA at diagnosis was 5.3 (4.3-7.1) ng/ml. The most represented Gleason Grade and clinical tumor stage were GG 1 (65%) and cT1 (88%). Follow-up time was 5.9 years (2.4-9.6). Prostate cancer-specific mortality was 2.7% within the follow-up period. Median PSA tests count after diagnosis was 8 (2-14) with a PSAs testing/years of 1.4 (0.4-2.7). Median biopsies count performed after diagnosis was 0 (0-1). Patients who underwent at least one re-biopsy were 544 (45%), ≥2 re-biopsies were 219 (18%), ≥3 re-biopsies were 75 (6%), with a median biopsies/year of 0.0 (0.0-0.2). At 10 years, the cumulative incidence of PCSM was 3.2%. Conclusions: Our data reported discrepancies with guidelines regarding follow-up intensity for AS patients, particularly concerning biopsies, which occurred less frequently than recommended. While our cohort showed a trend towards PSA testing in alignment with AUA and NCCN, re-biopsies were underutilized according to all three guidelines. These findings emphasize the importance of patient education and counseling regarding AS follow-up, as an integral part of this management strategy. Our report is one of the few on the intensity of AS monitoring in a “real-world” practice.
Volume
85
First Page
S1869
Last Page
S1869
