Appropriateness Criteria for Active Surveillance of Prostate Cancer

Michael L. Cher*, Apoorv Dhir, Gregory B. Auffenberg, Susan Linsell, Yuqing Gao, Bradley Rosenberg, S. Mohammad Jafri, Laurence Klotz, David C. Miller, Khurshid R. Ghani, Steven J. Bernstein, James E. Montie, Brian R. Lane

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Purpose The adoption of active surveillance varies widely across urological communities, which suggests a need for more consistency in the counseling of patients. To address this need we used the RAND/UCLA Appropriateness Method to develop appropriateness criteria and counseling statements for active surveillance. Materials and Methods Panelists were recruited from MUSIC urology practices. Combinations of parameters thought to influence decision making were used to create and score 160 theoretical clinical scenarios for appropriateness of active surveillance. Recent rates of active surveillance among real patients across the state were assessed using the MUSIC registry. Results Low volume Gleason 6 was deemed highly appropriate for active surveillance whereas high volume Gleason 6 and low volume Gleason 3+4 were deemed appropriate to uncertain. No scenario was deemed inappropriate or highly inappropriate. Prostate specific antigen density, race and life expectancy impacted scores for intermediate and high volume Gleason 6 and low volume Gleason 3+4. The greatest degree of score dispersion (disagreement) occurred in scenarios with long life expectancy, high volume Gleason 6 and low volume Gleason 3+4. Recent rates of active surveillance use among real patients ranged from 0% to 100% at the provider level for low or intermediate biopsy volume Gleason 6, demonstrating a clear opportunity for quality improvement. Conclusions By virtue of this work urologists have the opportunity to present specific recommendations from the panel to their individual patients. Community-wide efforts aimed at increasing rates of active surveillance and reducing practice and physician level variation in the choice of active surveillance vs treatment are warranted.

Original languageEnglish (US)
Pages (from-to)67-74
Number of pages8
JournalJournal of Urology
Volume197
Issue number1
DOIs
StatePublished - Jan 1 2017

Keywords

  • counseling
  • decision making
  • program evaluation
  • prostatic neoplasms
  • watchful waiting

ASJC Scopus subject areas

  • Urology

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