Use of monitoring tests remains low among prostate cancer patients under observation

Low use of recommended monitoring tests, including repeat prostate biopsy, persists among patients with localized prostate cancer undergoing observation, a recent study has found.

This retrospective cohort study was conducted among Medicare beneficiaries diagnosed with low- or intermediate-risk prostate cancer in 2004‒2016, who were initially managed with observation for at least 12 months. The rates of prostate-specific antigen (PSA) testing, prostate biopsy, and prostate magnetic resonance imaging (MRI) were examined.

The authors determined whether PSA testing and prostate biopsy rates increased over time using multivariable mixed effects Poisson regression. They also identified clinical, sociodemographic, and provider factors associated with the frequency of monitoring tests during observation.

A total of 10,639 patients diagnosed at a median age of 73 years were included in the study. The median follow-up after diagnosis was 4.3 years.

Among patients managed without treatment for 5 years, 98 percent received at least one PSA test, 48.0 percent had one or more additional prostate biopsy, and 31.0 percent underwent at least one prostate MRI. Among those managed with observation for ≥12 months, rates of PSA testing (relative risk [RR], 1.02, 95 percent confidence interval [CI], 1.02‒1.03) and biopsy (RR, 1.10, 95 percent CI, 1.08‒1.11) increased over time, as shown in mixed effects Poisson regression.

In addition, clinical and sociodemographic factors, such as age, race/ethnicity, clinical risk, census tract poverty, and region correlated with PSA testing and biopsy rates.