Login to Access Video or Poster Abstract: MP43-02
Sources of Funding: Blue Cross and Blue Shield of Michigan and grant 1T32-CA180984 from the National Cancer Institute.

Introduction

Recognizing the importance of fully characterizing cancer severity prior to Active Surveillance (AS), many advocate for confirmatory testing (e.g., repeat biopsy, MRI) shortly after prostate cancer (CaP) diagnosis. In this context, we examined utilization of such testing among AS eligible men across urology practices in Michigan.

Methods

The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a consortium of 43 urology practices. We identified all men with newly-diagnosed CaP entered into the collaborative&[prime]s registry from January 2012 through April 2016 that met MUSIC&[prime]s published AS appropriateness criteria (i.e., age < 80, any Gleason Score ≤6 or Gleason Score 3+4 with ≤3 positive cores and no more than 50% of any core involved). Among men with sufficient follow-up, we first calculated the proportion that received a confirmatory test (defined as receipt of a repeat prostate biopsy or prostate MRI) within 6 months and 12 months after diagnosis, respectively. For practices with at least 10 AS eligible patients, we then assessed practice-level variation in the rates of confirmatory testing. Finally, we fit regression models to identify characteristics associated with receipt of a confirmatory test.

Results

During this time period, 434/5,292 (7.6 %) and 695/4,614 (15.1%) eligible men received confirmatory testing within 6 and 12 months of diagnosis, respectively. At a practice level, rates of confirmatory testing varied widely for both the 6- (0 % to 27.5%; p<0.001) and 12-month intervals (0 % to 60.0%; p<0.001) (Figure). Patients with GS 3+4 tumors and PSA levels > 4 were less likely to undergo confirmatory testing, while such tests were more frequent among patients diagnosed more recently and in larger practices (Table).

Conclusions

Although increasing over time, utilization of repeat biopsy or prostate MRI to confirm risk stratification among men who are candidates for AS has been uncommon and highly variable across urology practices. These data have prompted ongoing efforts in MUSIC to increase and standardize use of such tests among men considering AS.

Funding

Blue Cross and Blue Shield of Michigan and grant 1T32-CA180984 from the National Cancer Institute.