Concordance of confirmatory prostate biopsy in active surveillance with national guidelines: An analysis from the multi-institutional PURC cohort.

Autor: Talwar R; Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: ruchika.talwar@pennmedicine.upenn.edu., Friel B; Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA., Mittal S; Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA., Xia L; Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA., Fonshell C; Health Care Improvement Fondation, Philadelphia, PA., Danella J; Department of Urology, Geisinger Medical Center, Danville, PA., Jacobs B; Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA., Lanchoney T; Urology Health Specialists, Hershey, PA., Raman J; Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA., Tomaszewski J; Division of Urology, MD Anderson Cancer Center at Cooper University, Camden, NJ., Trabulsi E; Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA., Reese A; Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA., Singer EA; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ., Ginzburg S; Department of Urology, Einstein Healthcare Network, Philadelphia, PA., Smaldone M; Division of Urology, Fox Chase Cancer Center, Philadelphia, PA., Uzzo R; Division of Urology, Fox Chase Cancer Center, Philadelphia, PA., Mucksavage P; Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA., Guzzo TJ; Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA., Lee DJ; Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Jazyk: angličtina
Zdroj: Urologic oncology [Urol Oncol] 2020 Nov; Vol. 38 (11), pp. 846.e17-846.e22. Date of Electronic Publication: 2020 Jul 29.
DOI: 10.1016/j.urolonc.2020.07.008
Abstrakt: Purpose: National Comprehensive Cancer Network (NCCN) guidelines recommend confirmatory biopsy within 12 months of active surveillance (AS) enrollment. With <10 cores on initial biopsy, re-biopsy should occur within 6 months. Our objective was to determine if patients on AS within practices in the Pennsylvania Urologic Regional Collaborative (PURC) receive guideline concordant confirmatory biopsies.
Materials and Methods: Within PURC, a prospective collaborative of diverse urology practices in Pennsylvania and New Jersey, we identified men enrolled in AS after first biopsy, analyzing time to re-biopsy and factors associated with various intervals of re-biopsy.
Results: In total, 1,047 patients were enrolled in AS for a minimum of 12 months after initial biopsy. Four hundred seventy-seven (45%) underwent second biopsy at 1 of the 9 PURC practices. The number of patients undergoing re-biopsy within 6 months, 6 to 12 months, 12 to 18 months, and >18 months was 71 (14%), 218 (45.7%), 134 (28%), and 54 (11%), respectively. Sixty percent underwent confirmatory biopsy within 12 months. On multivariate analysis, re-biopsy interval was associated with number of positive cores, perineural invasion, and practice ID (all P < 0.05). Adjusted multivariable regression did not identify factors predictive of re-biopsy interval.
Conclusion: Of patients who underwent confirmatory biopsy at PURC practices, 60.5% were within 12 months per NCCN guidelines. This suggests area for improvement in guideline adherence after enrollment in AS. All practices that offer AS should periodically perform similar analyses to monitor their performance. In an era of value-based care, adherence to guideline based active surveillance practices may eventually comprise national quality metrics affecting provider reimbursement.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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