Lewis Katz School of Medicine at Temple University , Philadelphia , Pennsylvania.
Geisinger Medical Center , Danville.
J Urol. 2019 May;201(5):929-936. doi: 10.1016/j.juro.2018.10.018.
We describe contemporary active surveillance utilization and variation in a regional prostate cancer collaborative. We identified demographic and disease specific factors associated with active surveillance in men with newly diagnosed prostate cancer.
We analyzed data from the PURC (Pennsylvania Urologic Regional Collaborative), a cooperative effort of urology practices in southeastern Pennsylvania and New Jersey. We determined the rates of active surveillance among men with newly diagnosed NCCN® (National Comprehensive Cancer Network®) very low, low or intermediate prostate cancer and compared the rates among participating practices and providers. Univariate and multivariable analyses were used to identify factors associated with active surveillance utilization.
A total of 1,880 men met inclusion criteria. Of the men with NCCN very low or low risk prostate cancer 57.4% underwent active surveillance as the initial management strategy. Increasing age was significantly associated with active surveillance (p <0.001) while adverse clinicopathological variables were associated with decreased active surveillance use. Substantial variation in active surveillance utilization was observed among practices and providers.
More than 50% of men with low risk disease in the PURC collaborative were treated with active surveillance. However, substantial variation in active surveillance rates were observed among practices and providers in academic and community settings. Advanced age and favorable clinicopathological factors were strongly associated with active surveillance. Analysis of regional collaboratives such as the PURC may allow for the development of strategies to better standardize treatment in men with prostate cancer and offer active surveillance in a more uniform and systematic fashion.
我们描述了一个区域性前列腺癌协作组中当代主动监测的使用情况和变化。我们确定了与新诊断前列腺癌患者接受主动监测相关的人口统计学和疾病特异性因素。
我们分析了 PURC（宾夕法尼亚州泌尿科区域协作）的数据，这是宾夕法尼亚州东南部和新泽西州泌尿科实践的合作努力。我们确定了新诊断的 NCCN（国家综合癌症网络®）极低、低或中危前列腺癌患者中接受主动监测的比例，并比较了参与实践和提供者之间的比例。使用单变量和多变量分析来确定与主动监测使用相关的因素。
共有 1880 名男性符合纳入标准。在 NCCN 极低或低危前列腺癌患者中，57.4%的患者将主动监测作为初始管理策略。年龄的增加与主动监测显著相关（p <0.001），而不利的临床病理变量与主动监测使用减少相关。实践和提供者之间主动监测的使用存在很大差异。
在 PURC 协作组中，超过 50%的低危疾病男性接受了主动监测。然而，在学术和社区环境中的实践和提供者之间，主动监测率存在很大差异。高龄和有利的临床病理因素与主动监测密切相关。对 PURC 等区域协作的分析可以制定更好地规范前列腺癌患者治疗的策略，并以更统一和系统的方式提供主动监测。
