JU INSIGHT Use of Monitoring Tests Among Patients With Localized Prostate Cancer Managed With Observation
By: Michael S. Leapman, MD, Yale School of Medicine, New Haven, Connecticut, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut, Yale School of Public Health, New Haven, Connecticut; Rong Wang, PhD, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut, Yale School of Public Health, New Haven, Connecticut; Stacy Loeb, MD, New York University, Langone Health, New York, Manhattan Veterans Affairs Medical Center, New York; Tyler M. Seibert, PhD, MD, University of California San Diego, La Jolla; Franklin D. Gaylis, MD, Genesis Healthcare, San Diego, California; Ben Lowentritt, MD, Chesapeake Urology, Baltimore, Maryland; Gordon A. Brown, DO, New Jersey Urology, Bloomfield; Ronald Chen, MD, MPH, University of Kansas Medical Center, Kansas City; Daniel Lin, MD, University of Washington, Seattle, Fred Hutchinson Cancer Research Center, Cancer Prevention Program, Public Health Sciences, Seattle, Washington; John Witte, MS, PhD, Stanford University, Palo Alto, California; Matthew R. Cooperberg, MD, MPH, University of California San Francisco; William J. Catalona, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Cary P. Gross, MD, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut, Yale School of Medicine, New Haven, Connecticut; Xiaomei Ma, PhD, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut, Yale School of Public Health, New Haven, Connecticut | Posted on: 20 Apr 2023
Leapman MS, Wang R, Loeb S, et al. Use of monitoring tests among patients with localized prostate cancer managed with observation. J Urol. 2023;209(4):710-718.
Study Need and Importance
Active surveillance is the recommended initial strategy for patients with low-risk prostate cancer and is increasingly selected by patients with intermediate-risk disease. Despite increased uptake in the United States, little is known about compliance with recommended monitoring tests used to identify disease reclassification during active surveillance including PSA testing, prostate biopsy, and prostate MRI.
What We Found
We performed a retrospective cohort study of low- and intermediate-risk Medicare beneficiaries in the Surveillance, Epidemiology, and End Results (SEER) database. Among 10,639 patients diagnosed with prostate cancer between 2004 and 2016 and followed with observation for at least 12 months, most (98%) had at least 1 PSA test, 48% underwent a repeat prostate biopsy, and 31% underwent a prostate MRI. Rates of PSA 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; see Figure).
In this administrative claims–based analysis, we were unable to assess whether observation for prostate cancer was undertaken in the context of active surveillance or intended watchful waiting.
Interpretation for Patient Care
In this national study of Medicare beneficiaries with prostate cancer, we found that use of recommended monitoring tests including repeat prostate biopsy increased over time but remain low. These findings can help refine strategies to improve the safety, tolerability, and outcome of patients with prostate cancer managed with active surveillance.