Platinum Priority – Prostate Cancer
Editorial by Matthew R. Cooperberg on pp. 51–52 of this issue

Contemporary Use of Initial Active Surveillance Among Men in Michigan with Low-risk Prostate Cancer eulogo1

By: Paul R. Womble a lowast , James E. Montie a , Zaojun Ye a , Susan M. Linsell a , Brian R. Lane b and David C. Miller a for the Michigan Urological Surgery Improvement Collaborative.

European Urology, Volume 67 Issue 1, January 2015, Pages 44-50

Published online: 01 January 2015

Keywords: Low-risk prostate cancer, Active surveillance, Quality improvement collaborative

Abstract Full Text Full Text PDF (413 KB) Patient Summary



Active surveillance (AS) has been proposed as an effective strategy to reduce overtreatment among men with lower risk prostate cancers. However, historical rates of initial surveillance are low (4–20%), and little is known about its application among community-based urology practices.


To describe contemporary utilization of AS among a population-based sample of men with low-risk prostate cancer.

Design, setting, and participants

We performed a prospective cohort study of men with low-risk prostate cancer managed by urologists participating in the Michigan Urological Surgery Improvement Collaborative (MUSIC).

Outcome measurements and statistical analysis

The principal outcome was receipt of AS as initial management for low-risk prostate cancer including the frequency of follow-up prostate-specific antigen (PSA) testing, prostate biopsy, and local therapy. We examined variation in the use of surveillance according to patient characteristics and across MUSIC practices. Finally, we used claims data to validate treatment classification in the MUSIC registry.

Results and limitations

We identified 682 low-risk patients from 17 MUSIC practices. Overall, 49% of men underwent initial AS. Use of initial surveillance varied widely across practices (27–80%;p = 0.005), even after accounting for differences in patient characteristics. Among men undergoing initial surveillance with at least 12 mo of follow-up, PSA testing was common (85%), whereas repeat biopsy was performed in only one-third of patients. There was excellent agreement between treatment assignments in the MUSIC registry and claims data (κ = 0.93). Limitations include unknown treatment for 8% of men with low-risk cancer.


Half of men in Michigan with low-risk prostate cancer receive initial AS. Because this proportion is much higher than reported previously, our findings suggest growing acceptance of this strategy for reducing overtreatment.

Patient summary

We examined the use of initial active surveillance for the management of men with low-risk prostate cancer across the state of Michigan. We found that initial surveillance is used much more commonly than previously reported, but the likelihood of a patient being placed on surveillance depends strongly on where he is treated.

Take Home Message

We report contemporary practice patterns for the use of active surveillance among patients with low-risk prostate cancer managed in the large number of diverse academic and community practices comprising the Michigan Urological Surgery Improvement Collaborative. We observed that nearly 50% of men with low-risk prostate cancer undergo initial surveillance rather than definitive local therapy, with significant variation across urology practices throughout the state. The validation steps taken in this analysis underscore the accuracy of these estimates, and our findings indicate a significant transition in patterns of care for men with low-risk prostate cancer.

Keywords: Low-risk prostate cancer, Active surveillance, Quality improvement collaborative.


a Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA

b Spectrum Health Medical Group Urology, Michigan State University College of Human Medicine, Grand Rapids, MI, USA

lowast Corresponding author. Department of Urology, University of Michigan, NCRC Building 16, 100S-13, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, USA. Tel. +1 734 647 9188; Fax: +1 734 232 2400.

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