Variation in Guideline Concordant Active Surveillance Followup in Diverse Urology Practices.
We examined the frequency of followup prostate specific antigen testing and prostate biopsy among men treated with active surveillance in the academic and community urology practices comprising MUSIC (Michigan Urological Surgery Improvement Collaborative).



MUSIC is a consortium of 42 practices that maintains a prospective clinical registry with validated clinical data on all patients diagnosed with prostate cancer at participating sites. We identified all patients in MUSIC practices who entered active surveillance and had at least 2 years of continuous followup. After determining the frequency of repeat prostate specific antigen testing and prostate biopsy, we calculated rates of concordance with NCCN Guidelines® recommendations (ie at least 3 prostate specific antigen tests and 1 surveillance biopsy) collaborative-wide and across individual practices.



We identified 513 patients who entered active surveillance from January 2012 through September 2013 and had at least 2 years of followup. Among the 431 men (84%) who remained on active surveillance for 2 years 132 (30.6%) underwent followup surveillance testing at a frequency that was concordant with NCCN® (National Comprehensive Cancer Network®) recommendations. At the practice level, the median rate of guideline concordant followup was 26.5% (range 10% to 67.5%, p <0.001). Among patients with discordant followup, the absence of followup biopsy was common and not significantly different across practices (median rate 82.0%, p = 0.35).



Among diverse community and academic practices in Michigan, there is wide variation in the proportion of men on active surveillance who meet guideline recommendations for followup prostate specific antigen testing and repeat biopsy. These data highlight the need for standardized active surveillance pathways that emphasize the role of repeat surveillance biopsies.
Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan.
Amy N
AN
Luckenbaugh
Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan.
Gregory B
GB
Auffenberg
Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan.
Scott R
SR
Hawken
Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan.
Apoorv
A
Dhir
Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan.
Susan
S
Linsell
Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan.
Sanjeev
S
Kaul
Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan. Electronic address: dcmiller@med.umich.edu.
David C
DC
Miller
Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan.
D000368:Aged; D001706:Biopsy; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008824:Michigan; D018579:Patient Selection; D011159:Population Surveillance; D010818:Practice Patterns, Physicians'; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*; D014572:Urology; D057832:Watchful Waiting
D017430:Prostate-Specific Antigen
biopsy; prostate-specific antigen; prostatic neoplasms; quality improvement; watchful waiting
J Natl Compr Canc Netw. 2015 Dec;13(12 ):1534-61
26656522
J Clin Oncol. 2011 Jun 1;29(16):2185-90
21464416
J Natl Compr Canc Netw. 2010 Feb;8(2):162-200
20141676
Eur Urol. 2015 Nov;68(5):814-21
26138043
Eur Urol. 2012 Dec;62(6):976-83
22698574
J Urol. 2013 Nov;190(5):1742-9
23727309
J Urol. 2007 Jun;177(6):2106-31
17509297
J Urol. 2015 Aug;194(2):403-9
25896556
Am J Manag Care. 2014 Nov;20(11 Spec No. 17):SP502-10
25811824
J Natl Compr Canc Netw. 2014 May;12(5):686-718
24812137
J Urol. 2016 Sep;196(3):721-6
26946161
Curr Urol Rep. 2010 May;11(3):165-71
20425623
Cancer. 2011 May 15;117(10):2058-66
21523717
J Urol. 2014 Jul;192(1):75-80
24518783
Cancer. 2008 Jun 15;112(12):2664-70
18433013
Urology. 2015 Nov;86(5):901-5
26358397
Eur Urol. 2013 Apr;63(4):597-603
23159452
JAMA. 2015 Jul 7;314(1):80-2
26151271
J Natl Compr Canc Netw. 2016 Jan;14 (1):19-30
26733552
J Urol. 2015 Mar;193(3):807-11
25261803
Eur Urol. 2015 Jan;67(1):44-50
25159890
J Natl Cancer Inst. 2006 Aug 16;98(16):1134-41
16912266