Introduction

Prostate cancer management trends have been described previously using a variety of data sources, but none has captured actual national data across a broad range of practice types and locations. We explored management trends in the new AUA Quality (AQUA) Registry.

Methods

The AQUA Registry collects data from participating practices via automated data extraction from local electronic health record systems. Data are collected from both structured (e.g., billing codes, prescriptions) and unstructured (e.g., pathology reports, physician notes) chart elements. We identified newly diagnosed prostate cancer cases using a series of data rules and algorithms.

Results

From Jan. 2014 to Jun. 2016, the AQUA Registry collected data on 35,437 men with prostate cancer from 64 practices. Localized prostate cancer disease was found in 22,861. The median number of localized cases per site was 112 (range 1-2768, IQR 36-315). A total of 16,485 (72%) had sufficient data to calculate risk; the missing data rate fell from 33% in 2014 to 23% in 2016. Of men with sufficient data, 42%, 35%, and 23% had low, intermediate, and high-risk disease, respectively. The proportion of low-risk cases fell from 45% in 2014 to 40% in 2016, the differences are reflected in rising rates of high-risk disease (p<0.001). The Figure below illustrates treatment trends over time for 15,825 men with identified primary treatment. The rate of active surveillance for low-risk disease rose from 41% in 2014 to 54% in 2016. Medication data were available for 5154 men receiving advanced disease medications; 32.5% of these received more than one medication. In total, 2089 men received abiraterone, 2289 enzalutamide, 320 docetaxesl, 81 cabazitaxel, 334 sipuleucel-T, 108 radium-223, and 2290 denosumab. Among 738 men receiving both abiraterone and enzalutamide, 66% received abiraterone first; the median time starting these two medications was 232 days.

Conclusions

We confirmed prior reports from less representative registries in terms of shifting prostate cancer risk distribution and high and rising rates of active surveillance for low-risk disease. The AQUA Registry provides unique data on patterns of use for advanced prostate cancer medications. Many more urology practices have recently joined the registry and therefore, the numbers of men represented will grow rapidly.

Funding

none