Not-so watchful waiting: prostate cancer protocols not followed

GU cancer

By Tessa Hoffman

2 Mar 2018

Most men assigned to ‘active surveillance’ for prostate cancer are not receiving the recommended follow-up care, urologists have found.

Findings presented at the Urological Society of Australia and New Zealand (USANZ) annual conference in Brisbane on 27 February, suggest that three out of four men with low risk prostate cancers are not receiving the recommended PSA surveillance and biopsies when assigned to active surveillance rather than intervention to remove the prostate cancer.

The findings come from a study that investigated adherence to standard protocols for Active Surveillance among 1635 men in the two years after a prostate cancer diagnosis (Gleason Grade group 3 or less) between 2008-14, based on Victorian cancer registry data.

It found 73.5% of men did not receive adequate follow-up in line with the protocol, which calls for three or more PSA tests and one or more biopsy in the two years after diagnosis on biopsy.

Study co-author Professor Mark Frydenberg, a consultant urologist and past president of the Urological Society of Australia and New Zealand (USANZ), said some men had longer gaps between PSA tests while others missed out on biopsies. However, he noted that some practitioners substituted MRI for biopsy, a strategy which he said was arguably a good approach.

Professor Frydenberg said the findings highlighted the need for better promotion of active surveillance protocols – based on the PRIAS (Prostate Cancer Research International: Active Surveillance) model – in urology and GP circles.

“It’s a reminder for GPs, urologists and radiation oncologists, all of whom manage men on active surveillance, that they do need to be doing all the right things to make sure men are safe,” Professor Frydenberg told the limbic.

It is also important to inform patients about the protocol, because there are cases where patients don’t turn up for scheduled tests, he added.

The findings also point to the need to fund public hospitals to develop their own dedicated urology units, something that is sorely lacking.

“We found it was a much bigger problem in public hospitals than private practices,” said Professor Frydenberg.

The researchers said the clinical consequences of sub-optimal follow up during active surveillance were unknown.

According to Professor Frydenberg, the chances of patients coming to great harm were “relatively low as long as they still get seen”.

“But we do know about 20-30% of patients do progress and need surgery or radiotherapy. In those people you don’t want to delay treatment.

“If it’s delayed by three months, six months, 12 months because people aren’t following protocols, there’s obviously a risk to the patient the disease might be more extensive by the time you get to treat it.”

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