Osterberg EC, et al. – Researchers aimed to define demographic, disease, and cancer outcomes of men on active surveillance (AS) at a safety–net hospital and characterize those who were lost to follow–up (LTFU). According to the findings, AS for low–risk prostate cancer (PCa) is challenging among a vulnerable population receiving care in a safety–net hospital, as rates of LTFU were high. The outcomes illustrate the need for AS support programs to improve adherence and follow–up among vulnerable and underserved populations.

Methods

• In this study, 104 men with low–risk prostate cancer (PCa) were followed with AS at Zuckerberg San Francisco General Hospital (ZSFG) between January 2004 to November 2014.
• Criteria for AS have evolved over time; nevertheless, patients with diagnostic prostate–specific antigen (PSA) 10 ng/mL or less, clinical stage T1/2, biopsy Gleason score 3 + 3 or 3 + 4, 33% or fewer positive cores, and 50% or less tumor in any single core were potentially eligible for AS.
• At every 3 to 6 months, men were longitudinally followed with a PSA or digital rectal examination or both, and repeat prostate biopsy every 1 to 2 years.
• Thereafter, clinical staging and grading were based on a physical examination and at least a 12–core biopsy, respectively.
• They characterized LTFU as failure to successfully contact patients with 3 phone calls or any urology visit recorded within 18 months from a prior visit or biopsy.
• They further conducted a secondary chart review applying the electronic medical record at ZSFG as well as EPIC Systems CareEverywhere which allows access to select non–ZSFG institutions to confirm that patients were truly LTFU.

Results

• The median age at diagnosis of PCa was 61.5 years (range: 44–81) among the 104 men on AS at ZSFG.
• For this analysis, the median follow–up period was 29 months (range: 0–186 months) during which 18 (17.3%) men were LTFU and 48 (46%) remained on surveillance.
• Men underwent a median of 7 (1–21) serum PSA measurements and an average of 2 prostate biopsies (1–5).
• Overall, 22 (20.6%) men had definitive treatment with the median time from diagnosis to active treatment being 26 (range: 2–87) months.
• It was indicated that radiation therapy was more common than radical prostatectomy (12.5% vs. 7.7%).
• They observed 1 PCa–related death and 3 noncancer deaths.
• It was showed that initial adherence to AS was poor; nevertheless, men committed to AS initially were ultimately more compliant over time.