AS Rate Increasing for Low-Risk PCa

Study identifies a concomitant decline in the use of radical prostatectomy and radiation therapy

THE PROPORTION OF men with low-risk prostate cancer (PCa) managed initially with active surveillance (AS) more than doubled from 2014 to mid2021 in the United States, with a concomitant decrease in the use of active treatments, according to investigators.

Matthew Cooperberg, MD, of the University of California, San Francisco, and colleagues examined data from the AUA Quality (AQUA) Registry, which was launched by the AUA in 2013 to help urology practices understand and improve their quality of care and streamline reporting as mandated by the Centers for Medicare and Medicaid Services. Data are obtained directly from a range of electronic health record systems at participating practices. By mid-2021, the registry included data from 1945 urologists at 349 practices across the United States.

The investigators analyzed data from 20,809 men with low-risk PCa and known primary treatment. The patients had a median age of 65 years at diagnosis. The proportion of men managed with AS rose from 26.5% in 2014 to 59.6% in the first half of 2021, Dr Cooperberg and colleagues reported in a poster presentation. During that same period, the proportion of men treated with radical prostatectomy decreased from 29.7% to 15.8% and the proportion who received external beam radiation therapy decreased from 28.2% to 20.9%.

The proportion of patients with lowrisk PCa managed with AS ranged from 4% to 78% at the practice level and 0% to 100% at the provider level.

Overall, AS rates were not meaningfully different between Black and White patients (39.4% and 39.8%, respectively).

On logistic regression, age, year of diagnosis, and provider volume of lowrisk disease were strongly associated with AS receipt, whereas race and practice volume of low-risk disease were not, according to the investigators.

“AS rates are improving but are still suboptimal, and variation across providers is excessive,” the investigators concluded.

The latest findings are consistent with those of previous studies. In a paper published in JAMA, Brandon A. Mahal, MD, of the Dana-Farber Cancer Institute in Boston, and colleagues reported that the use of AS or watchful waiting (WW) for men with low-risk PCa increased from 14.5% in 2020 to 42.1% in 2015. During the same period, use of RP declined from 47.4% to 31.3% and use of radiation therapy decreased from 38.0% to 26.6%. ■

Complications Following RC Are Declining

RADICAL cystectomy (RC) complications overall appear to be decreasing in the United States, investigators reported.

Using the 2006-2018 American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) database, investigators identified 11,351 RC cases. Mean hospital length of stay (LOS) significantly decreased from 10.5 to 9.8 to 8.6 days, across the 3 contemporary eras: 20062011, 2012-2014, and 2015-2018, respectively, likely reflecting improvements in perioperative care, Kevin Chua, MD, of Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, reported on behalf of his team.

The readmission rate held steady at 20.0%, 21.3%, and 21.0%, respectively. The 30-day mortality rate also remained unchanged at 2.7%, 1.7%, and 2.0%, respectively.

The rate of any postoperative complication significantly decreased from 56.5% in 2006-2011 to 50.6% in 2015-2018, Dr Chua reported. The rate of major complications within 30 days of RC did not change significantly. Sepsis rates remained high. Deep incisional surgical site infections, however, decreased from 1.9% to 0.8%. Pulmonary embolism significantly decreased from 3.0% to 1.5%.

The rate of minor complications within 30 days of RC significantly declined from 46.4% in 2006-2011 to 41.0% in 2015-2018. Superficial surgical site infections significantly decreased from 6.5% to 4.6% and transfusions from 34.2% to 31.7% over the 12-year span. But the rate of urinary tract infections stayed the same.

“An analysis of the contemporary era shows continued decrease in LOS after RC and a decrease in overall complications,” Dr Chua and colleagues concluded in a study abstract. “This may reflect beneficial effects of changes in perioperative bladder cancer management such as increased use of neoadjuvant chemotherapy, enhanced recovery after surgery protocols and laparoscopic/robotic techniques.” ■

Rapid Rise in Active Surveillance

An analysis of data from 20,809 men with low-risk prostate cancer and known primary treatment revealed that the use of active surveillance (AS) more than doubled from 2014 to mid-2021, with concomitant decreases in the use of radical prostatectomy (RP) and external beam radiation therapy (EBRT).

60

50

40

30

20

10

0 ■ 2014 ■ Mid-2021

26.5% 59.6% 29.7% 15.8% 28.2% 20.9% AS RP EBRT

Source: Cooperberg M, et al. Active surveillance for low-risk prostate cancer: Time trends and variation in the AUA Quality (AQUA) Registry. Presented at: AUA2022, May 13-16, 2022. Poster MP43-03.

Kidneys from Donors With COVID-19 Safe to Transplant

TRANSPLANTING KIDNEYS from COVID19-positive deceased donors appears to be safe, according to researchers.

At an American Urological Association press conference, Alvin Wee, MD, MBA, program director for kidney transplantation at Glickman Urologic and Kidney Institute at Cleveland Clinic in Ohio, reported results from 55 patients (36 men and 19 women) who received kidneys from 34 deceased donors who tested positive for COVID-19 from February to October 2021. Donor selection criteria evolved to the point that only COVID-19-positive donors without significant primary or secondary kidney injury were selected. The average Kidney Donor Profile Index was 36.9.

Among recipients, 67.3% completed standard 2-dose COVID-19 vaccination prior to surgery, whereas 7.3% received 1 dose and 25.5% were not vaccinated. By 4 weeks after transplant surgery, no recipient had tested positive for COVID-19 on polymerase chain reaction assays, the study found. There was no change in postoperative management, including immunosuppression.

Delayed graft function occurred in 19.6% of the recipients, which the investigators attributed to more donation after cardiac death (59%) and longer cold ischemia time. At a mean 3.5 months of follow-up, all grafts were functional. They observed no transmission of COVID-19 through transplantation.

Kidneys from COVID-19-positive donors are safe to transplant and recipient outcomes are not different from regular donors, the investigators noted in their study abstract. ■