Abstract: PD40-05
Sources of Funding: None

Introduction

The curability of high-risk prostate cancer (PCa) may depend on early diagnosis and compliance with management modalities. Delayed or incomplete treatment for PCa may result in inferior clinical outcomes and lower survival rates. We sought to identify the proportion of and predictors of loss of follow-up care after positive prostate biopsy in a single-institution, retrospective cohort study

Methods

Patients who did not follow up for or so-called ‘defaulted’ treatment were defined as those who had failed to return for treatment or follow-up discussion after diagnosis of PCa. This did not include patients who elected to be treated at other hospitals. Demographic and clinical characteristics, were compared between defaulters and non-defaulters. A multiple linear regression was performed to predict those individuals likely to default.

Results

From October 2008 to April 2013, 6182 patients received 12,930 PSA tests at a single institution. Of these patients, 574 (9%) patients had at least one PSA test level greater than 4 ng/mL. A total of 210 patients had subsequent biopsy, of which 141 had a PSA test >4 ng/mL. PCa was detected in 85 (41%) patients, of which 17 (20%) patients failed to follow up. The majority (88%) of defaulters were made aware of their biopsy results prior to self-cessation of care. Defaulters were significantly younger (61.8 ± 2.0y) at time of biopsy compared to non-defaulters (65.8 ± 1.0y), t(83) = 1.8, p = 0.04. Those individuals with an unspecified primary care provider (65%) were more likely to default than those who had primary care doctor at our institution (p<.001). Defaulters were more likely to be uninsured (24%) as compared to those with continued care (4%) (p=.01). Defaulters were more likely to self-identify as Latino (41%) as compared to those with continued care (9%) (p=.01). A multiple regression predicted default from age, insurance status, race and PCP access, p < .0005, R2 = .430.

Conclusions

At our institution men at highest risk of being lost to follow-up after the diagnosis of prostate cancer were younger, uninsured, Latino, and without centralized care. In our cohort, defaulters had high-risk disease (81% of Gleason >=7), which is crucial to identify in a timely and aggressive fashion so as to prevent future treatment failure. Development of strategies to encourage prompt and continued attendance is needed in addition to qualitative research to better understand the reasons for default and underpinning risk factors.

Funding

None