Physician researchers at the Wayne State University School of Medicine have revealed that about 10 percent of men with low risk prostate cancer who delay treatment in favor of active surveillance become lost to follow up, or LFTU.
“In other words, they might not keep their appointments and periodic testing,” said Professor and Chair of Urology Michael Cher, M.D.
Active surveillance has recently emerged as the preferred management strategy for men with prostate cancer, but lack of longitudinal monitoring may increase the risk of poor outcomes. The researchers identified a cohort of patients over a six-year period from 44 academic and community urology practices.
The study “Risk of Becoming Lost to Follow-up During Active Surveillance for Prostate Cancer,” published in the current issue of the journal European Urology, provides a meaningful basis for practice improvement to decrease the number of men who are LTFU.
Risk factors for LFTU include being African American and in poor general health. LTFU was defined as any 18-month period where no pertinent surveillance testing was entered in the registry.
“Together with colleagues in the Michigan Urologic Surgery Improvement Collaborative, or MUSIC, we have been leaders in the state of Michigan regarding the concept of ‘active surveillance’ whereby men with favorable risk prostate cancer -- low grade -- can delay treatment, sometimes indefinitely, and therefore avoid some of the unfavorable side effects of treatment such as erectile dysfunction,” Dr. Cher added.
Not all men with prostate cancer require radical treatment such as radical prostatectomy or radiation. Under the active surveillance program, men must be followed carefully by their urologists in order to undergo testing to detect progression of prostate cancer.
“If disease progression is detected, we then recommend moving from active surveillance to treatment. A criticism of this approach is that men on active surveillance may become lost to follow up,” said Urology Chief Resident Kevin Ginsburg, M.D., a study author. “We set out to characterize this potential problem across the state of Michigan.”
These results are part of an ongoing active surveillance research program with Wayne State and MUSIC to improve the safety and quality of prostate cancer care, which has resulted in several publications over the last few years.