Discontinuation of Active Surveillance Without Risk Reclassification Prior to Treatment

Document Type

Conference Proceeding

Publication Date


Publication Title

Journal of Urology


INTRODUCTION AND OBJECTIVE: Guideline organizations support the use of active surveillance (AS) for all men with low risk (LR)and select men with favorable intermediate risk (FIR) prostate cancer(PC). Although encouraging AS as the initial approach for favorable-risk PC is an important first step in reducing overtreatment, this strategy is incomplete as it ignores another source of overtreatment: delayed treatment of men on AS who have not had risk reclassification. We evaluated the proportion of men that transitioned from AS to treatment without risk reclassification. METHODS: We reviewed the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry for men diagnosed with NCCN LRPC and FIRPC that underwent treatment after a period of AS to identify the proportion of men that did not have risk reclassification prior to treatment. Reclassification was defined as meeting any criteria for NCCN FIRPC for men initially diagnosed with LRPC and any criteria for NCCN unfavorable intermediate risk PC for men initially diagnosed with FIRPC.RESULTS: From 2013 to 2021, 2118 men in MUSIC underwent treatment after initial AS, of which 741 (35%) did not have risk reclas-sification prior to treatment. A higher proportion of men with FIRPC underwent treatment without risk reclassification compared with LRPC(50% vs. 29%, p





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American Urological Association Annual Meeting, April 28 - May 1, 2023, Chicago, IL