The Effect of Surgical Volume on Treatment of Favorable Risk Prostate Cancer

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVE: While the use of active surveillance (AS) for men with favorable-risk prostate cancer (FR PC) has increased, there are still notable variations. Several factors may influence treatment decisions, including those at the physician and patient levels. Our study evaluates the volume outcome relationship in this patient population. Specifically, we ask if the volume of radical prostatectomies (RPs) performed in a practice influences treatment for newly diagnosed FR PC. METHODS: We retrospectively reviewed the Michigan Urological Surgical Improvement Collaborative (MUSIC) registry and identified all men with prostate cancer from 2021-2023. We included FR PC patients according to biopsy and pre-treatment PSA meeting either NCCN very low risk (VLR), low risk (LR) or favorable intermediate risk (F-IR) PC and at least one year of follow up from diagnosis. The primary outcome was the use of AS for patients with FR PC. The primary independent variable was annualized RP volume in a practice, which was scaled by the number of urologists performing prostate biopsies. Each practice was placed into one of three groups: low (< 10 RP/urologist/year), medium (10-20 RP/urologist/year), high (>20 RP/urologist/year). A mixed-effects logistic regression model was used to assess for the association of practice RP volume and the selection of AS among patients with FR PC. RESULTS: At 33 MUSIC practices, 5,916 patients were diagnosed with FR PC. 21 sites were categorized as low volume, while 10 sites were medium volume and 2 sites were high volume. Figure 1 depicts the rate of AS for each included practice. In VLR PC patients, the rate of AS for low, medium and high volume was 95%, 93% and 89%, respectively. Meanwhile, in LR PC patients, the rate of AS for low, medium and high volume RP/urologist practices was 85%, 80%, and 68%, respectively. Finally, for F-IR PC, the rate of AS for low, medium and high volume was 46%, 41% and 39%. In the multivariable model, RP volume was not significantly associated with the selection of AS (p[0.13). CONCLUSIONS: The majority of patients with VLR and LR PC in MUSIC are placed on initial active surveillance regardless of practice surgical volume per urologist. For F-IR, less than half are placed on initial AS with minimal variation in surgical volume. Urology practice prostatectomy volume was not adversely associated with the use of active surveillance.

Volume

213

Issue

5S

First Page

e256

Last Page

e256

Comments

American Urological Association Annual Meeting, April 26-29, Las Vegas, NV

DOI

10.1097/01.JU.0001109792.00985.9d.10

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