Using Electronic Health Record Data to Identify Prostate Cancer Patients That May Qualify for Active Surveillance

Area of Science:

• Urology
• Oncology
• Health Informatics
• Quality Improvement Science

Background:

• Increased prostate cancer (PCa) detection via PSA testing has led to more low-risk diagnoses.
• Active Surveillance (AS) is a viable alternative to immediate treatment for low-risk PCa, with comparable mortality rates to surgery.
• AS may help patients avoid complications associated with surgery, radiation, or hormone therapy.

Purpose of the Study:

• To describe the electronic identification of Active Surveillance (AS) candidates using evidence-based criteria.
• To evaluate the feasibility of using electronic health records (EHRs) for identifying AS candidates.
• To assess practice patterns and identify quality improvement opportunities in PCa management.

Main Methods:

• A quality improvement study utilized a delivery system science framework.
• Electronic health records of 649 patients who underwent prostate biopsy were analyzed.
• Automated and manual data abstraction, along with ROC analysis, were used to compare AS-eligible patients with actual treatment received.

Main Results:

• 24.7% of the study population met the "AS-eligible" criteria.
• 39.1% of patients were treated using an AS approach (no surgery, radiation, or androgen deprivation therapy).
• Guideline adherence was estimated at 0.70 (95% CI: 0.66-0.73), indicating feasible implementation.

Conclusions:

• Implementing evidence-based criteria for AS candidate detection is feasible using EHR data.
• This approach provides a basis for evaluating practice patterns and driving quality improvement in PCa care.
• Electronic identification facilitates the assessment of adherence to AS guidelines.