Contemporary use of initial active surveillance among men in Michigan with low-risk prostate cancer.
Identifieur interne : 000E51 ( Main/Exploration ); précédent : 000E50; suivant : 000E52Contemporary use of initial active surveillance among men in Michigan with low-risk prostate cancer.
Auteurs : Paul R. Womble [États-Unis] ; James E. Montie [États-Unis] ; Zaojun Ye [États-Unis] ; Susan M. Linsell [États-Unis] ; Brian R. Lane [États-Unis] ; David C. Miller [États-Unis]Source :
- European urology [ 1873-7560 ] ; 2015.
Descripteurs français
- KwdFr :
- Adulte d'âge moyen (MeSH), Antigène spécifique de la prostate (sang), Appréciation des risques (MeSH), Biopsie (statistiques et données numériques), Enregistrements (MeSH), Humains (MeSH), Michigan (MeSH), Mâle (MeSH), Observation (surveillance clinique) (statistiques et données numériques), Prostate (anatomopathologie), Services de santé communautaires (statistiques et données numériques), Sujet âgé (MeSH), Tumeurs de la prostate (anatomopathologie), Tumeurs de la prostate (sang), Tumeurs de la prostate (thérapie), Urologie (statistiques et données numériques), Études prospectives (MeSH).
- MESH :
- anatomopathologie : Prostate, Tumeurs de la prostate.
- sang : Antigène spécifique de la prostate, Tumeurs de la prostate.
- statistiques et données numériques : Biopsie, Observation (surveillance clinique), Services de santé communautaires, Urologie.
- thérapie : Tumeurs de la prostate.
- Adulte d'âge moyen, Appréciation des risques, Enregistrements, Humains, Michigan, Mâle, Sujet âgé, Études prospectives.
English descriptors
- KwdEn :
- Aged (MeSH), Biopsy (statistics & numerical data), Community Health Services (statistics & numerical data), Humans (MeSH), Male (MeSH), Michigan (MeSH), Middle Aged (MeSH), Prospective Studies (MeSH), Prostate (pathology), Prostate-Specific Antigen (blood), Prostatic Neoplasms (blood), Prostatic Neoplasms (pathology), Prostatic Neoplasms (therapy), Registries (MeSH), Risk Assessment (MeSH), Urology (statistics & numerical data), Watchful Waiting (statistics & numerical data).
- MESH :
- chemical , blood : Prostate-Specific Antigen.
- blood : Prostatic Neoplasms.
- pathology : Prostate, Prostatic Neoplasms.
- statistics & numerical data : Biopsy, Community Health Services, Urology, Watchful Waiting.
- therapy : Prostatic Neoplasms.
- Aged, Humans, Male, Michigan, Middle Aged, Prospective Studies, Registries, Risk Assessment.
Abstract
BACKGROUND
Active surveillance (AS) has been proposed as an effective strategy to reduce overtreatment among men with lower risk prostate cancers. However, historical rates of initial surveillance are low (4-20%), and little is known about its application among community-based urology practices.
OBJECTIVE
To describe contemporary utilization of AS among a population-based sample of men with low-risk prostate cancer.
DESIGN, SETTING, AND PARTICIPANTS
We performed a prospective cohort study of men with low-risk prostate cancer managed by urologists participating in the Michigan Urological Surgery Improvement Collaborative (MUSIC).
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
The principal outcome was receipt of AS as initial management for low-risk prostate cancer including the frequency of follow-up prostate-specific antigen (PSA) testing, prostate biopsy, and local therapy. We examined variation in the use of surveillance according to patient characteristics and across MUSIC practices. Finally, we used claims data to validate treatment classification in the MUSIC registry.
RESULTS AND LIMITATIONS
We identified 682 low-risk patients from 17 MUSIC practices. Overall, 49% of men underwent initial AS. Use of initial surveillance varied widely across practices (27-80%; p=0.005), even after accounting for differences in patient characteristics. Among men undergoing initial surveillance with at least 12 mo of follow-up, PSA testing was common (85%), whereas repeat biopsy was performed in only one-third of patients. There was excellent agreement between treatment assignments in the MUSIC registry and claims data (κ=0.93). Limitations include unknown treatment for 8% of men with low-risk cancer.
CONCLUSIONS
Half of men in Michigan with low-risk prostate cancer receive initial AS. Because this proportion is much higher than reported previously, our findings suggest growing acceptance of this strategy for reducing overtreatment.
PATIENT SUMMARY
We examined the use of initial active surveillance for the management of men with low-risk prostate cancer across the state of Michigan. We found that initial surveillance is used much more commonly than previously reported, but the likelihood of a patient being placed on surveillance depends strongly on where he is treated.
DOI: 10.1016/j.eururo.2014.08.024
PubMed: 25159890
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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Miller</name><affiliation wicri:level="2"><nlm:affiliation>Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI</wicri:regionArea><placeName><region type="state">Michigan</region></placeName></affiliation></author></analytic><series><title level="j">European urology</title><idno type="eISSN">1873-7560</idno><imprint><date when="2015" type="published">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term><term>Biopsy (statistics & numerical data)</term><term>Community Health Services (statistics & numerical data)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Michigan (MeSH)</term><term>Middle Aged (MeSH)</term><term>Prospective Studies (MeSH)</term><term>Prostate (pathology)</term><term>Prostate-Specific Antigen (blood)</term><term>Prostatic Neoplasms (blood)</term><term>Prostatic Neoplasms (pathology)</term><term>Prostatic Neoplasms (therapy)</term><term>Registries (MeSH)</term><term>Risk Assessment (MeSH)</term><term>Urology (statistics & numerical data)</term><term>Watchful Waiting (statistics & numerical data)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte d'âge moyen (MeSH)</term><term>Antigène spécifique de la prostate (sang)</term><term>Appréciation des risques (MeSH)</term><term>Biopsie (statistiques et données numériques)</term><term>Enregistrements (MeSH)</term><term>Humains (MeSH)</term><term>Michigan (MeSH)</term><term>Mâle (MeSH)</term><term>Observation (surveillance clinique) (statistiques et données numériques)</term><term>Prostate (anatomopathologie)</term><term>Services de santé communautaires (statistiques et données numériques)</term><term>Sujet âgé (MeSH)</term><term>Tumeurs de la prostate (anatomopathologie)</term><term>Tumeurs de la prostate (sang)</term><term>Tumeurs de la prostate (thérapie)</term><term>Urologie (statistiques et données numériques)</term><term>Études prospectives (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Prostate-Specific Antigen</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Prostate</term><term>Tumeurs de la prostate</term></keywords><keywords scheme="MESH" qualifier="blood" xml:lang="en"><term>Prostatic Neoplasms</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Prostate</term><term>Prostatic Neoplasms</term></keywords><keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Antigène spécifique de la prostate</term><term>Tumeurs de la prostate</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Biopsy</term><term>Community Health Services</term><term>Urology</term><term>Watchful Waiting</term></keywords><keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr"><term>Biopsie</term><term>Observation (surveillance clinique)</term><term>Services de santé communautaires</term><term>Urologie</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Prostatic Neoplasms</term></keywords><keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Tumeurs de la prostate</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Humans</term><term>Male</term><term>Michigan</term><term>Middle Aged</term><term>Prospective Studies</term><term>Registries</term><term>Risk Assessment</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Appréciation des risques</term><term>Enregistrements</term><term>Humains</term><term>Michigan</term><term>Mâle</term><term>Sujet âgé</term><term>Études prospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Active surveillance (AS) has been proposed as an effective strategy to reduce overtreatment among men with lower risk prostate cancers. However, historical rates of initial surveillance are low (4-20%), and little is known about its application among community-based urology practices.</p></div><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>To describe contemporary utilization of AS among a population-based sample of men with low-risk prostate cancer.</p></div><div type="abstract" xml:lang="en"><p><b>DESIGN, SETTING, AND PARTICIPANTS</b></p><p>We performed a prospective cohort study of men with low-risk prostate cancer managed by urologists participating in the Michigan Urological Surgery Improvement Collaborative (MUSIC).</p></div><div type="abstract" xml:lang="en"><p><b>OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS</b></p><p>The principal outcome was receipt of AS as initial management for low-risk prostate cancer including the frequency of follow-up prostate-specific antigen (PSA) testing, prostate biopsy, and local therapy. We examined variation in the use of surveillance according to patient characteristics and across MUSIC practices. Finally, we used claims data to validate treatment classification in the MUSIC registry.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS AND LIMITATIONS</b></p><p>We identified 682 low-risk patients from 17 MUSIC practices. Overall, 49% of men underwent initial AS. Use of initial surveillance varied widely across practices (27-80%; p=0.005), even after accounting for differences in patient characteristics. Among men undergoing initial surveillance with at least 12 mo of follow-up, PSA testing was common (85%), whereas repeat biopsy was performed in only one-third of patients. There was excellent agreement between treatment assignments in the MUSIC registry and claims data (κ=0.93). Limitations include unknown treatment for 8% of men with low-risk cancer.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Half of men in Michigan with low-risk prostate cancer receive initial AS. Because this proportion is much higher than reported previously, our findings suggest growing acceptance of this strategy for reducing overtreatment.</p></div><div type="abstract" xml:lang="en"><p><b>PATIENT SUMMARY</b></p><p>We examined the use of initial active surveillance for the management of men with low-risk prostate cancer across the state of Michigan. We found that initial surveillance is used much more commonly than previously reported, but the likelihood of a patient being placed on surveillance depends strongly on where he is treated.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">25159890</PMID><DateCompleted><Year>2015</Year><Month>07</Month><Day>28</Day></DateCompleted><DateRevised><Year>2018</Year><Month>12</Month><Day>02</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1873-7560</ISSN><JournalIssue CitedMedium="Internet"><Volume>67</Volume><Issue>1</Issue><PubDate><Year>2015</Year><Month>Jan</Month></PubDate></JournalIssue><Title>European urology</Title><ISOAbbreviation>Eur Urol</ISOAbbreviation></Journal><ArticleTitle>Contemporary use of initial active surveillance among men in Michigan with low-risk prostate cancer.</ArticleTitle><Pagination><MedlinePgn>44-50</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0302-2838(14)00777-5</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.eururo.2014.08.024</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Active surveillance (AS) has been proposed as an effective strategy to reduce overtreatment among men with lower risk prostate cancers. However, historical rates of initial surveillance are low (4-20%), and little is known about its application among community-based urology practices.</AbstractText><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">To describe contemporary utilization of AS among a population-based sample of men with low-risk prostate cancer.</AbstractText><AbstractText Label="DESIGN, SETTING, AND PARTICIPANTS" NlmCategory="METHODS">We performed a prospective cohort study of men with low-risk prostate cancer managed by urologists participating in the Michigan Urological Surgery Improvement Collaborative (MUSIC).</AbstractText><AbstractText Label="OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS" NlmCategory="METHODS">The principal outcome was receipt of AS as initial management for low-risk prostate cancer including the frequency of follow-up prostate-specific antigen (PSA) testing, prostate biopsy, and local therapy. We examined variation in the use of surveillance according to patient characteristics and across MUSIC practices. Finally, we used claims data to validate treatment classification in the MUSIC registry.</AbstractText><AbstractText Label="RESULTS AND LIMITATIONS" NlmCategory="CONCLUSIONS">We identified 682 low-risk patients from 17 MUSIC practices. Overall, 49% of men underwent initial AS. Use of initial surveillance varied widely across practices (27-80%; p=0.005), even after accounting for differences in patient characteristics. Among men undergoing initial surveillance with at least 12 mo of follow-up, PSA testing was common (85%), whereas repeat biopsy was performed in only one-third of patients. There was excellent agreement between treatment assignments in the MUSIC registry and claims data (κ=0.93). Limitations include unknown treatment for 8% of men with low-risk cancer.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Half of men in Michigan with low-risk prostate cancer receive initial AS. Because this proportion is much higher than reported previously, our findings suggest growing acceptance of this strategy for reducing overtreatment.</AbstractText><AbstractText Label="PATIENT SUMMARY" NlmCategory="RESULTS">We examined the use of initial active surveillance for the management of men with low-risk prostate cancer across the state of Michigan. We found that initial surveillance is used much more commonly than previously reported, but the likelihood of a patient being placed on surveillance depends strongly on where he is treated.</AbstractText><CopyrightInformation>Published by Elsevier B.V.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Womble</LastName><ForeName>Paul R</ForeName><Initials>PR</Initials><AffiliationInfo><Affiliation>Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA. Electronic address: pwomble@med.umich.edu.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Montie</LastName><ForeName>James E</ForeName><Initials>JE</Initials><AffiliationInfo><Affiliation>Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ye</LastName><ForeName>Zaojun</ForeName><Initials>Z</Initials><AffiliationInfo><Affiliation>Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Linsell</LastName><ForeName>Susan M</ForeName><Initials>SM</Initials><AffiliationInfo><Affiliation>Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lane</LastName><ForeName>Brian R</ForeName><Initials>BR</Initials><AffiliationInfo><Affiliation>Spectrum Health Medical Group Urology, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Miller</LastName><ForeName>David C</ForeName><Initials>DC</Initials><AffiliationInfo><Affiliation>Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><CollectiveName>Michigan Urological Surgery Improvement Collaborative</CollectiveName></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2014</Year><Month>08</Month><Day>24</Day></ArticleDate></Article><MedlineJournalInfo><Country>Switzerland</Country><MedlineTA>Eur Urol</MedlineTA><NlmUniqueID>7512719</NlmUniqueID><ISSNLinking>0302-2838</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>EC 3.4.21.77</RegistryNumber><NameOfSubstance UI="D017430">Prostate-Specific Antigen</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Eur Urol. 2015 Jan;67(1):51-2</RefSource><PMID Version="1">25242556</PMID></CommentsCorrections><CommentsCorrections RefType="CommentIn"><RefSource>J Urol. 2015 Jan;193(1):128-9</RefSource><PMID Version="1">25523659</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001706" MajorTopicYN="N">Biopsy</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003153" MajorTopicYN="N">Community Health Services</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008824" MajorTopicYN="N">Michigan</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011467" MajorTopicYN="N">Prostate</DescriptorName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017430" MajorTopicYN="N">Prostate-Specific Antigen</DescriptorName><QualifierName UI="Q000097" MajorTopicYN="Y">blood</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011471" MajorTopicYN="N">Prostatic Neoplasms</DescriptorName><QualifierName UI="Q000097" MajorTopicYN="N">blood</QualifierName><QualifierName UI="Q000473" MajorTopicYN="Y">pathology</QualifierName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012042" MajorTopicYN="N">Registries</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018570" MajorTopicYN="N">Risk Assessment</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014572" MajorTopicYN="N">Urology</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D057832" MajorTopicYN="N">Watchful Waiting</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Active surveillance</Keyword><Keyword MajorTopicYN="N">Low-risk prostate cancer</Keyword><Keyword MajorTopicYN="N">Quality improvement collaborative</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2014</Year><Month>06</Month><Day>05</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2014</Year><Month>08</Month><Day>11</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2014</Year><Month>8</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2014</Year><Month>8</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2015</Year><Month>7</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">25159890</ArticleId><ArticleId IdType="pii">S0302-2838(14)00777-5</ArticleId><ArticleId IdType="doi">10.1016/j.eururo.2014.08.024</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>États-Unis</li></country><region><li>Michigan</li></region></list><tree><country name="États-Unis"><region name="Michigan"><name sortKey="Womble, Paul R" sort="Womble, Paul R" uniqKey="Womble P" first="Paul R" last="Womble">Paul R. Womble</name></region><name sortKey="Lane, Brian R" sort="Lane, Brian R" uniqKey="Lane B" first="Brian R" last="Lane">Brian R. Lane</name><name sortKey="Linsell, Susan M" sort="Linsell, Susan M" uniqKey="Linsell S" first="Susan M" last="Linsell">Susan M. Linsell</name><name sortKey="Miller, David C" sort="Miller, David C" uniqKey="Miller D" first="David C" last="Miller">David C. Miller</name><name sortKey="Montie, James E" sort="Montie, James E" uniqKey="Montie J" first="James E" last="Montie">James E. Montie</name><name sortKey="Ye, Zaojun" sort="Ye, Zaojun" uniqKey="Ye Z" first="Zaojun" last="Ye">Zaojun Ye</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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