Outcomes of men on active surveillance for low-risk prostate cancer at a safety-net hospital

E Charles Osterberg; Nynikka R A Palmer; Catherine R Harris; Gregory P Murphy; Sarah D Blaschko; Carissa Chu; Isabel E Allen; Matthew R Cooperberg; Peter R Carroll; Benjamin N Breyer

doi:10.1016/j.urolonc.2017.07.003

Outcomes of men on active surveillance for low-risk prostate cancer at a safety-net hospital

Urol Oncol. 2017 Nov;35(11):663.e9-663.e14. doi: 10.1016/j.urolonc.2017.07.003. Epub 2017 Aug 18.

Affiliations

¹ Department of Urology, University of California San Francisco, San Francisco, CA; Department of Surgery, Dell Medical School, University of Texas, San Francisco, CA.
² Department of Urology, University of California San Francisco, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA.
³ Department of Urology, University of California San Francisco, San Francisco, CA.
⁴ Department of Urology, University of California San Francisco, San Francisco, CA. Electronic address: Benjamin.breyer@ucsf.edu.

PMID: 28826701
DOI: 10.1016/j.urolonc.2017.07.003

Abstract

Purpose: To characterize demographic, disease, and cancer outcomes of men on active surveillance (AS) at a safety-net hospital and characterize those who were lost to follow-up (LTFU).

Methods: From January 2004 to November 2014, 104 men with low-risk prostate cancer (PCa) were followed with AS at Zuckerberg San Francisco General Hospital (ZSFG). Criteria for AS have evolved over time; however, patients with diagnostic prostate-specific antigen (PSA) 10ng/mL or less, clinical stage T1/2, biopsy Gleason score 3 + 3 or 3 + 4, 33% or fewer positive cores, and 50% or less tumor in any single core were potentially eligible for AS. Men were longitudinally followed with a PSA or digital rectal examination or both every 3 to 6 months, and repeat prostate biopsy every 1 to 2 years. Clinical staging and grading were based on a physical examination and at least a 12-core biopsy, respectively. LTFU was defined as failure to successfully contact patients with 3 phone calls or any urology visit recorded within 18 months from a prior visit or biopsy. A secondary chart review was performed using the electronic medical record at ZSFG as well as EPIC Systems CareEverywhere which allows access to select non-ZSFG institutions to confirm that patients were truly LTFU.

Results: Among the 104 men on AS at ZSFG, the median age at diagnosis of PCa was 61.5 years (range: 44-81). The median follow-up period was 29 months (range: 0-186 months) during which 18 (17.3%) men were LTFU and 48 (46%) remained on surveillance. Men underwent a median of 7 (1-21) serum PSA measurements and an average of 2 prostate biopsies (1-5). In total, 22 (20.6%) men had definitive treatment with the median time from diagnosis to active treatment being 26 (range: 2-87) months. Radiation therapy was more common than radical prostatectomy (12.5% vs. 7.7%). There was 1 PCa-related death and 3 noncancer deaths. Initial adherence to AS was poor; however, men committed to AS initially were ultimately more compliant over time.

Conclusion: AS for low-risk PCa is challenging among a vulnerable population receiving care in a safety-net hospital, as rates of LTFU were high. Our findings suggest the need for AS support programs to improve adherence and follow-up among vulnerable and underserved populations.

Keywords: Active surveillance; Patient compliance; Prostate cancer; Safety-net hospital.

MeSH terms

Adult
Aged
Aged, 80 and over
Biopsy
Digital Rectal Examination / methods*
Follow-Up Studies
Humans
Male
Middle Aged
Outcome Assessment, Health Care / methods
Outcome Assessment, Health Care / statistics & numerical data
Prostate / pathology
Prostate / radiation effects*
Prostate / surgery*
Prostate-Specific Antigen / blood*
Prostatic Neoplasms / pathology
Prostatic Neoplasms / therapy*
Risk Factors
Safety-net Providers

Substances

Prostate-Specific Antigen