Prostate Cancer Treated with Active Surveillance Compared to NCCN guidelines for Surveillance - PDF Document

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Prostate Cancer Treated with Active Surveillance Compared to NCCN guidelines for Surveillance

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  1. Prostate Cancer Treated with Active Surveillance Compared to NCCN guidelines for Surveillance Date: Date Presented to Cancer Committee: July 9, 2015 By Shelly Smits, RHIT, CCS, CTR Conclusions by Ian Thompson, MD Data Source: Cancer registry information on prostate cancer patients diagnosed 2010 through June 30, 2014. The cases diagnosed from 2010 through 2012 were evaluated using NCCN guidelines. Reason for Report: To determine if prostate cancer patients who were treated with active surveillance were followed using the NCCN guideline recommendations. This was initiated after discussion of a recent study regarding the change in recommendations for doing PSA screening and more active surveillance. Findings: There were 430 cases of prostate cancer diagnosed between 2010-2012 and 173 diagnosed between January 1, 2013 and June 30, 2014. During the 2010-2012 time period, 103 patients were treated with active surveillance and 61 during January 2013 and June 2014. The table below shows the percentage of patients treated with active surveillance by year of diagnosis. Prostate Cancer at PeaceHealth St. Joseph Med Ctr Diagnosed January 2010-June 2014 Percent treated with active surveillance Total cases Surveillance % surveil 2010 2011 2012 2013 156 156 118 112 61 32 42 29 42 19 21% 27% 24.50% 38% 31% Jan--Jun 2014 NCCN guidelines place clinically localized prostate cancers into four risk groups, very low, low, intermediate and high. This study looked at those patients with very low (T1c, Gleason score equal to or less than 6, PSA less than 10 and fewer than three biopsy cores positive) and low (T1-T2a, Gleason score equal to or less than 6 and PSA less than 10) risk. The following table shows the distribution of very low and low risk cases for the years 2010-2012. NCCN guideline very low or low risk Groups PeaceHealth St. Joseph Medical Center Date of initial diagnosis 2010-2012 Treated with Active Surveillance as first course Very Low* 2010 11 2011 19 2012 12 *T1c, PSA<10, Gleason=or<6, 3 or less cores + **T1-2a, PSA<10, Gleason =or<6 Low** 2 1 1

  2. Table showing distribution of cases showing PSA and Gleason score values: Prostate cancer diagnoses PeaceHealth St. Joseph Medical Center Date of initial diagnosis 2010-June 2014 Treated with Active Surveillance as first course Active Surveillance Treatment PSA Value 10 to 20 Unk or >20 Gleason Score 7 8 Total cases Surveillance % surveil <10 6 9 susp for ca 2010 2011 2012 2013 156 156 118 112 61 32 42 29 42 19 21% 27% 24.50% 38% 31% 27 35 18 31 12 1 2 5 5 2 4 5 6 4 5 20 31 24 26 13** 6 9 4 14 4 2 0 0 0 0 1 0 0 0 1 3 2 1* 2 1 Jan--Jun 2014 **one Gleason 5 NCCN recommendations for active surveillance: •PSA no more often than every 6 months unless clinically indicated •DRE no more oftern then every 12 months unless clinical indicated •Repeat prostate biopsy nor more often than every 12 months unless clincally indicated Below is a table to the VERY LOW risk prostate cancers and the percentage getting the recommended PSA and biopsies. This information was obtained from the hospital electronic medical record. The urology physicians’ documentation is not always available there. Prostate Cancer, Very low risk (VLR) PeaceHealth St. Joseph Medical Center Date of Initial Diagnosis Jan 2010 to June 2014 Active Surveillance as first course treatment Repeat PSA 2010 10 (91%) 2011 15 (79%) 2012 10 (83%) Next Steps: Create a tool for monitoring patients who have chosen active surveillance. Dr. Michael Taylor will work on this tool to be presented later this (2015) Fall. Conclusions: text. *Repeat bx 1 yr later was neg. Total VLR 11 19 12 Repeat bx. 6 (54.5%) 9 (47.4%) 8 (66.7%)