Evaluating the Importance of Practice-level Factors on Adherence to Prostate Cancer Treatment Guidelines in Urology

To evaluate adherence to treatment guideline recommendations across the continuum of prostate cancer (PCa) care by US community urologists using several PCa-specific performance indicators (PIs). Additionally, to determine which practice-related factors, such as having a designated PCa patient champion, active patient management in a patient portal, and in-office dispensing of medications, were associated with improved PI performance.

Electronic medical record data were collected retrospectively from the PPS Analytics Patient Population Health Management Platform. The cohort consisted of adult patients with a PCa-related service visit during the period July 1, 2019 to June 30, 2022. Five PIs were reviewed: dual-energy x-ray absorptiometry scanning with androgen deprivation therapy (ADT), systemic therapy in metastatic PCa, external beam radiation therapy concurrent with ADT, image monitoring, and regular testosterone testing and monitoring.

A total of 101,186 patients were identified from 95 urology practices. PI adherence rates ranged from a low of 13.6% for a dual-energy x-ray absorptiometry scan within 6 months of ADT initiation to a high of 72.3% for external beam radiation therapy concurrent with ADT in intermediate-/high-risk localized PCa. The results also demonstrated that several practice-related features were associated with better PI adherence.

The findings suggest there exists a wide range in PI adherence rates for urologists in the delivery of community urology care in the United States compared to clinical guideline recommendations. Future research should examine the factors associated with PI nonadherence and promote implementation of interventions that enhance guideline-concordant care.