At the American Urological Association (AUA) meeting in New Orleans in May, there appeared to be a “light at the end of the tunnel” moment.
Matthew Cooperberg, MD, MPH, lead advocate for Active Surveillance (AS) at UCSF, announced that data from the AUA’s own AQUA registry has revealed for the first time that the majority of low-risk patients with prostate cancer (just under 60%) chose AS over rushing into an operating room or radiation therapy room. AS finally broke through academic practice and became mainstream.
A victory for our age? not yet. Not really. A sizeable 40% of US AS candidates still choose radiation or surgery.
The AUA committee is calling for greater adoption of AS, with a target of 80% within some vague time frame.
Then there was a speaker at the meeting, a voice from Michigan, which turned out to be a hotbed for urology reform, especially for AS with low-risk prostate cancer. Urological oncologist Kevin Ginsburg, MD, of Wayne State University in Detroit, stepped up to the microphone and said 80% simply wasn’t enough to be a goal, and called for a more aggressive move to AS.
Ginsburg is one of the leaders of MUSIC (Michigan Urology Improvement Collaborative), an innovative physician-led quality improvement collaboration founded in 2012 by the Michigan State of 46 urology clinics and is supported by Blue Cross Blue Shield Michigan.
he told the convention: “This is Kevin Kings Berg, I’m working with MUSIC. At MUSIC, we’ve been able to get a higher rate, over 90% by 2021. Why 80%? ) The only cause of prostate cancer for men with cancer is that they will harm and develop metastases or die from AS-related disease by delaying the treatment of prostate cancer. I’m not sure if the 20% of men with GG1 disease fall into this category.”
Of course this is not the case with this lazy cancer.
Ginsburg said that one of MUSIC’s overarching goals is to strengthen AS throughout the Mitten state, including academic practices, as well as large private and small practices. Nearly all of Michigan’s practices are part of MUSIC’s efforts to merge and share data to drive improved patient care and lower costs.
“It’s not just academic institutions like Wayne State and the University of Michigan saying, ‘Hey, let’s use active surveillance.’ It’s everyone buying and saying We could definitely use more aggressive surveillance in men with low-risk prostate cancer,” Ginsburg said.
Michigan has become the Sweden of US AS, largely due to the efforts of MUSIC, which helps physicians monitor their own practice and encourages adoption of AS. Through coordinated quality improvement efforts, the state has achieved rates of AS in over 90% of low-risk patients, comparable to rates in Sweden.
More than 268,000 American men will be diagnosed with prostate cancer in 2022, according to the American Cancer Society. Of these men, 35% (about 94,000) will have a low or very low risk Gleason score. Of these low or very low risk men, about 60% (56,400) in the US would choose AS
as an AS advocate, which to me is music. Cooperberg and Ginsberg point out that AS will never be 100% adopted. AS is not for everyone due to anxiety and other factors, but music suggests that AS acceptance rates may be higher.
MUSIC is demonstrating a model that should be adopted throughout the United States. Increasing acceptance rates through medical peers is more than voluntary monitoring support. MUSIC examines what can be changed in practice to improve outcomes in multiple areas of prostate cancer care. MUSIC’s collaborative model also produces a transcript for each practitioner and the whole.
“Everyone knows their own and the entire MUSIC’s data, but they don’t know everyone’s personal data. Otherwise, it’s too easy to generalize, and
think you are doing the right thing (like using a lot of AS) don’t know if you’re doing the right thing. Knowing your data is the first step to improvement,” Ginsburg said.
“One of the founding principles of MUSIC is that as a group we will be ‘collegiate and non-competitive’. As cliché as it sounds, we have a strong ‘tide’ ebb and flow” mentality. I wouldn’t say we had to use peer pressure because urologists at MUSIC are voluntary. MUSIC is a voluntary coalition. Urologists participate in MUSIC because they want the best for their patients Nursing,” he continued.
In addition to transcripts, MUSIC meets 3 times a year to discuss quality improvement topics related to prostate cancer care, kidney cancer care, and kidney stone care.
This brings us to “Whoosh” – a biopsy disinfectant technique.
Ginsburg said MUSIC looked at ways to increase sepsis-related hospitalization rates by 1 percent in biopsies.
“We got together and asked what could we do to make it safer? We actually found a lower rate of sepsis when urologists swabbed biopsy needles directly in formalin — —It decontaminates the needle —then they gargle with salt water or water and then do the next biopsy and we found these people had the lowest rates of infection,” he explained.
Doctors with higher rates of sepsis in patients simply rub the needle on the gauze that will be used to transfer the tissue into a container sent to the pathologist. MUSIC published its findings at BJU International. After adjusting for confounding factors, the findings were not statistically significant.
“It’s one of these variations in medicine. Do you start tying your shoes with the left foot or the right foot?? It’s something no one has ever thought about. We don’t think it matters. But actually, you can dig in and determine that this is one of the techniques we’ve found to help reduce the incidence of post-prostate infection after biopsy,” he said.
“While this study did not reach statistical significance, I still find it valuable. For me, a simple approach to reduce infectious hospitalizations by 0.3% or 0.5% maneuver, even if the change is not statistically significant, I still think it is clinically meaningful,” he added. (TP) biopsy. According to unpublished MUSIC data, hospitalization rates for infection were 0.6% after transrectal ultrasonography (TRUS) and 0.3% after TP.
Mainly doing TP biopsies now, but when I do TRUS, I swish,” Ginsburg points out. Several factors improve prostatectomy.
What is missing?
It seems to me that MUSIC and other researchers need to look at the psychology of AS, how anxiety and depression affect the decision-making process, and what can be done to Improving these uptake rates, and how to get more patients to use AS for longer. MUSIC needs to generate data on race and ethnicity, especially in black populations who are hard hit by prostate cancer but often stay away from AS.
Could the MUSIC model across the United States attempt to improve the quality of life of low-risk cancer patients, prevent damage from overtreatment of prostate cancer, or even switch to safer TP procedures?
“We are currently, and very selectively, investigating how we can extend the MUSIC model beyond Michigan,” said Ginsburg. Based on medical writers. Since 2016, he has contributed to MedPage Today writes the blog “The Patient Journey.” He is a member of the Substack Newsletter, TheActiveSurveillor.com.