Login to Access Video or Poster Abstract: MP14-02
Sources of Funding: Alafi Foundation

Introduction

Health care delivery to vulnerable and uninsured patients is challenging due to social and economic barriers. For men with low-risk prostate cancer (PCa) on active surveillance (AS), patient compliance, follow up, and access to care are essential for favorable cancer outcomes. Our primary objective is to characterize demographic, disease and cancer outcomes of men on AS at a safety-net hospital and characterize those who were loss to follow-up (LTFU). _x000D_

Methods

From January 2004 to November 2014, 104 men at Zuckerberg San Francisco General (ZSFG) with low-risk PCa were followed with AS. Criteria for AS has evolved over time; however, patients with diagnostic PSA 10ng/mL or less, clinical stage T1/2, biopsy Gleason grade 3+3 or 3+4, 33% or fewer positive cores and 50% or less tumor in any single core were eligible for AS. Men were longitudinally followed with a PSA and/or DRE every 3-6 months and repeat prostate biopsy every 1-2 years. Clinical staging and grading were based on a physical exam and at least a 12-core biopsy respectively. LTFU was defined as failure to contact patients with three phone calls or any urology visit recorded within 18 months from a prior visit or biopsy. A secondary chart review was performed with EPIC Systems© CareEverywhere which allows access to non-ZSFG institutions to confirm patients were truly LTFU.

Results

Among the 104 men on AS at ZSFG, the median age at diagnosis of PCa was 61.5 years (range: 44-81). The median follow-up time period was 29 months (0-186 months) during which 18 men were LTFU and 48 remained on surveillance. Men who remained on AS underwent a median of 7 (1-21) serum PSA measurements and an average of 2 prostate biopsies (1-5). In total, 22 (20.6%) men had definitive treatment with the median time from diagnosis to active treatment being 26 (2-87) months. Radiation therapy was more common that radical prostatectomy (12.5% versus 7.7%). There was one prostate cancer-related death and three non-cancer deaths. Kaplan-Meir curve analysis demonstrates that initial adherence to AS is poor; however as time progresses, adherence increases as those patients committed to early surveillance continue with follow-up.

Conclusions

AS for low-risk prostate cancer is challenging among a vulnerable population receiving care in a safety-net hospital, as rates of LTFU were high. Our findings suggest the need for an AS program to improve adherence and follow-up among vulnerable and underserved populations.

Funding

Alafi Foundation