Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
J Urol. 2022 Sep;208(3):600-608. doi: 10.1097/JU.0000000000002734. Epub 2022 May 6.
Men on active surveillance for favorable-risk prostate cancer do not receive all the recommended testing. Reasons for variation in receipt are unknown.
We combined prospective registry data from the Michigan Urological Surgery Improvement Collaborative, a collaborative of 46 academic and community urology practices across Michigan, with insurance claims from 2014 to 2018 for men on active surveillance for favorable-risk prostate cancer. We defined receipt of recommended surveillance according to the collaborative's low-intensity criteria as: annual prostate specific antigen testing and either magnetic resonance imaging or prostate biopsy every 3 years. We assessed receipt of recommended surveillance among men with ≥36 months of followup (246). We conducted multilevel analyses to examine the influence of the urologist, urologist and primary care provider visits, and patient demographic and clinical factors on variation in receipt.
During 3 years of active surveillance, just over half of men (56.5%) received all recommended surveillance testing (69.9% annual prostate specific antigen testing, 72.8% magnetic resonance imaging/biopsy). We found 19% of the variation in receipt was attributed to individual urologists. While increasing provider visits were not significantly associated with receipt, older men were less likely to receive magnetic resonance imaging/biopsy (≥75 vs <55 years, adjusted odds ratio 0.07; 95% confidence interval 0.01-0.81).
Nearly half of men on active surveillance for favorable-risk prostate cancer did not receive all recommended surveillance. While urologists substantially influenced receipt of recommended testing, exploring how to leverage patients and their visits with their primary care providers to positively influence receipt appears warranted.
接受主动监测的低危前列腺癌患者并未接受所有推荐的检查。导致这种差异的原因尚不清楚。
我们将密歇根泌尿外科学术改进协作组（密歇根州 46 家学术和社区泌尿科实践的合作组织）的前瞻性登记数据与 2014 年至 2018 年的保险索赔数据相结合，纳入接受低危前列腺癌主动监测的男性。我们根据协作组的低强度标准定义了接受推荐的监测：每年进行前列腺特异性抗原检测，每 3 年进行一次磁共振成像或前列腺活检。我们评估了 246 名随访时间≥36 个月男性接受推荐监测的情况。我们进行了多水平分析，以检查泌尿科医生、泌尿科医生和初级保健提供者就诊以及患者人口统计学和临床因素对接受推荐监测情况的影响。
在 3 年的主动监测期间，略超过一半的男性（56.5%）接受了所有推荐的监测检测（69.9%的年度前列腺特异性抗原检测，72.8%的磁共振成像/活检）。我们发现，接受推荐监测的情况有 19%归因于个体泌尿科医生。虽然就诊次数的增加与接受监测之间没有显著相关性，但年龄较大的男性不太可能接受磁共振成像/活检（≥75 岁与<55 岁相比，调整后的优势比为 0.07；95%置信区间为 0.01-0.81）。
近一半接受低危前列腺癌主动监测的患者未接受所有推荐的监测。虽然泌尿科医生对接受推荐检查的情况有很大影响，但探索如何利用患者及其与初级保健提供者的就诊来积极影响接受情况似乎是必要的。
