Men on AS receive guideline-driven care from community practices

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Independent urologists provide the same quality of care for men on active surveillance (AS) for prostate cancer as urologists in largely academic settings, compared with prior studies, according to research presented at LUGPA’s 2019 annual meeting in Chicago.

“Even in the real world, people on active surveillance are getting equivalent, guideline-appropriate management,” said Jeremy B. Shelton, MD, MSHS, a urologist in Los Angeles who updated attendees on the study.

Creating the cohort

The LUGPA active surveillance project, which is supported by an unrestricted grant from Genomic Health, Inc., was designed to assess the quality of care that AS patients receive from independent urologists.

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From 2013 to 2014, a research team led by Dr. Shelton and Neal D. Shore, MD, recruited nine LUGPA practices from across the country to participate in the study. In less than 2 years, the team accrued a large cohort of 557 AS patients treated by independent urologists that could be compared with large academic cohorts.

“In very short order, we made a very large, robust, contemporary cohort, which I think speaks to the opportunity of partnerships between researchers and community providers,” Dr. Shelton said.

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Earlier research on the LUGPA cohort found that adherence to AS was equivalent to that found in research cohorts from academic institutions after 3 years of follow-up in community practices. For this latest research presented at LUGPA, researchers followed 392 men who were on AS for at least 2 years to understand how closely their care followed National Comprehensive Cancer Network (NCCN) guidelines for AS.

According to Dr. Shelton, researchers found about one-third (32.1%) of LUGPA patients were managed according to NCCN guidelines. This represents a slightly higher compliance rate than the Michigan Urological Surgery Improvement Collaborative (MUSIC), also a community-based cohort, which reported 26.5% compliance with NCCN guidelines.

“The take-home message is that this large LUGPA cohort of independent practices that were not coordinating or comparing AS management plans in any formal way did similarly to the MUSIC cohort in compliance with guidelines during a similar time period,” said Dr. Shelton, who is preparing his third paper with findings from the LUGPA cohort.

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In addition, researchers found that almost all men (93%) treated at the LUGPA practices had at least one PSA follow-up test within the first year of diagnosis. Most AS patients had their first PSA about 3 months after diagnosis, their second PSA about 6 months after diagnosis, and their third PSA about a year after diagnosis, Dr. Shelton said.

The LUGPA research also found that more than 40% of AS patients had a repeat biopsy within 2 years, typically about 1 year following diagnosis. Although this percentage reflects “a fair use of repeat biopsy for that time period,” it still represents a potential area for further study to understand what is driving avoidance of repeat biopsy, Dr. Shelton said. “Understanding practice patterns is what can enable quality improvement, and this was the driving motivation behind the research to begin with.”

Refuting older research

Findings from the LUGPA cohort appear to offer a counterbalance to some published research suggesting that community-based urologists might have a financial incentive to manage prostate cancer patients with surgery or radiation rather than AS, Dr. Shelton said. In fact, this latest report suggests that independent and academic practices provide similar care.

“The care given by LUGPA practices is at least as good as what other published studies show,” Dr. Shelton said.