Contemporary Rates and Practice-Level Variation in Disease Burden Assessment Amongst Prostate Cancer Active Surveillance Patients: Data From a Statewide Quality Collaborative

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVES: Active surveillance (AS )has become the preferred treatment for men with favorable risk prostate cancer based on the safety demonstrated in long-term series and trials, largely from academic centers. However, the extent to which contemporary real-world practice, both in terms of patient selection in adherence to testing, mimics the reported protocols remains unknown. METHODS: We analyzed AS patients in the Michigan Urological Surgery Improvement Collaborative data registry from 1/1/2016 to 4/30/2024. We captured disease burden assessment (follow-up PSA,MRI, and biopsy). Rates of disease burden assessment after starting AS were estimated via cumulative incidence curves. Practice-level variability was compared by calculating rates after stratifying by practice. RESULTS: We identified 12,502 patients on AS. Characteristics are shown in the Table, stratified by NCCN risk grouping at the time of diagnosis. Estimated 1-year rate of follow-up PSA was 85%. Estimated 3-year rate of MRI was 46%, biopsy 51%, and either MRI or biopsy 68%. Practice-level variation was narrow for follow-up PSA (range 78% to 90%) but wide for either MRI or biopsy (range 20% to87%, Figure). CONCLUSIONS: Contemporary, real world practice patterns differ markedly from reported protocols. Only 2/3rds of men received a follow-up biopsy or MRI in the first three years from initiating AS. While this likely represents a significant quality gap amongst patients at higher risk of progression, there is clearly an appetite for less invasive surveillance amongst lower risk patients.

Volume

215

Issue

5S

First Page

e670

Last Page

e670

Comments

American Urological Association Annual Meeting, May 15-18, 2026, Washington, DC

DOI

10.1097/01.JU.0001191468.48904.a0.19

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