San Francisco, CA USA (UroToday.com) Dr. Gaylis and associates from Genesis Healthcare and UC-San Diego presented their data on the implementation and adoption of a prostate cancer active surveillance (AS) program in today’s poster session at the 2016 GU ASCO conference. The collaborative group assessed past AS rates, instituted a best practice protocol, and then measured adoption rates post-implementation.
The implemented surveillance strategy included: 1) Stage T1c; 2) PSA Density (PSAD) < 0.15 ng/mL/cc and absolute PSA level < 10 ng/mL; 3) Gleason ≤6; 4) ≤3 cores (+); and 5) No individual core with >50% involvement.
The study investigators retrospectively compared utilization rates of 4 AS paradigms, including 1) all newly diagnosed prostate cancer patients, 2) newly diagnosed prostate cancer patients treated at Genesis, 3) Patients eligible for AS per NCCN guidelines, and 4) Patients eligible for AS per newly adopted institutional guidelines.
AS rates were 13-18% using methods 1 and 2, and did not significantly change over the study period (8/2012-8/2014). AS increased from 32% to 58% using NCCN guidelines (p<0.001), and 44% to 83% using institutional guidelines (p<0.001).
The authors concluded that AS adoption improved following institution of evidence-based guidelines along with comparative reporting, and that selection criteria significantly impact adoption rates. Offering patients AS is being considered as a future measure of compliance. Finally, physicians should be engaged and vigilant in measuring and improving quality with the intent of ensuring optimal care for patients. The approach demonstrated in this work may be helpful as the US transitions from a volume-based to value-based system of reimbursement.
Presented By:
Dr. Franklin Gaylis, MD
Genesis Healthcare and University of California, San Diego
Reported By:
Nikhil Waingankar, MD at the 2016 Genitourinary Cancers Symposium - January 7 - 9, 2016 – San Francisco, CA
Fox Chase Cancer Center, Philadelphia, PA