Association Between Early Confirmatory Testing and the Adoption of Active Surveillance for Men With Favorable-risk Prostate Cancer - 02/08/18

Doi : 10.1016/j.urology.2018.04.038

Deborah R. Kaye ^a,^b,^* , Ji Qi ^a, Todd M. Morgan ^b, Susan Linsell ^a, Brian R. Lane ^c, James E. Montie ^a,^b, Michael L. Cher ^d, David C. Miller ^a,^b
for the
Michigan Urological Surgery Improvement Collaborative
^a Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
^b Department of Urology, University of Michigan, Ann Arbor, MI
^c Spectrum Health Urology, Grand Rapids, MI
^d Department of Urology, Wayne State University, Detroit, MI

^*Address correspondence to: Deborah R. Kaye, MD, MS, Dow Division for Urologic Health Services Research, University of Michigan, NCRC Building 16, Room 108E, 2800 Plymouth Road, Ann Arbor, MI 48109-2800.Dow Division for Urologic Health Services ResearchUniversity of MichiganNCRC Building 16, Room 108E, 2800 Plymouth RoadAnn ArborMI48109-2800

Abstract

Objective

To examine the relationship between the use and results of early confirmatory testing and persistence on active surveillance (AS).

Methods

We identified all men in the Michigan Urological Surgery Improvement Collaborative registry diagnosed with favorable-risk prostate cancer from June 2016 to June 2017. We next examined trends in the use of early confirmatory test(s), defined as repeat biopsy, prostate magnetic resonance imaging, or molecular classifiers obtained within 6 months of the initial cancer diagnosis, in patients with favorable-risk prostate cancer. We then compared the proportion of men remaining on AS 6 months after diagnosis according to reassuring vs nonreassuring results, also stratifying by age and Gleason score.

Results

Among 2529 patients, 32.7% underwent early confirmatory testing within 6 months of diagnosis. Its use increased from 25.4% in the second quarter of 2016 to 34.9% in the second quarter of 2017 (P = .025). Molecular classifiers were most frequently used (55%), followed by magnetic resonance imaging (34%) and repeat biopsy (11%). Sixty-four percent (n = 523) had a reassuring result. Rates of AS were higher for patients with early reassuring results; 82% remained on AS (n = 427) compared to 52% (n = 157) of those with nonreassuring results and 51% (n = 873) with no early confirmatory testing (P <.001).

Conclusion

Rates of AS are higher among men with early reassuring results, supporting the clinical utility of these tests. Nonetheless, high rates of AS among patients with nonreassuring results underscore the complexity of shared decision-making in this setting.

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Plan

Methods

Michigan Urological Surgery Improvement Collaborative

	Financial Disclosure: Todd M. Morgan was advisory board member of and received research funding from Myriad Genetics, he also received research funding from GenomeDx. David C. Miller received contract support from the Blue Cross Blue Shield of Michigan (BCBSM) for the Michigan Value Collaborative (MVC) and the Michigan Urological Surgery Improvement Collaborative (MUSIC). The remaining authors declare that they have no relevant financial interests.
	Funding Support: This project was supported by the National Cancer Institute (5-T32-CA-180984-03 to Deborah R. Kaye) and by Blue Cross Blue Shield of Michigan (BCBSM) as part of the BCBSM Value Partnerships Program. The opinions, beliefs and viewpoints expressed by the authors do not necessarily reflect those of BCBSM or any of its employees.
	Deborah R. Kaye contributed in conceptualization, formal analysis, methodology, original draft, review, and editing; Ji Qi contributed in formal analysis, validation, original draft, review, and editing; Todd M. Morgan contributed in conceptualization, investigation, methodology, original draft, review, and editing; Susan Linsell contributed in data curation, funding acquisition, methodology, project administration, review, and editing; Brian R. Lane contributed in investigation, methodology, original draft, review, and editing; James E. Montie contributed in conceptualization, formal analysis, methodology, original draft, review, and editing; Michael L. Cher contributed in investigation, methodology, original draft, review, and editing; and David C. Miller contributed in conceptualization, formal analysis, methodology, original draft, review, editing, data curation, and funding acquisition.