Follow-up Rates in Active Surveillance for Prostate Cancer Higher in University-Based vs Safety-Net Hospitals

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Socioeconomic status affects survivorship among men with metastatic prostate cancer.
Socioeconomic status affects survivorship among men with metastatic prostate cancer.

There is a significant difference in the failure to follow-up rates among patients undergoing active surveillance at a university-based hospital vs a safety-net hospital.1

Active surveillance involves careful, routine monitoring of low-grade prostate cancer for signs of progression. “Active surveillance can only be an effective strategy if patients actually undergo surveillance,” said the investigators in a study recently presented at the 2017 Genitourinary Cancer symposium.

The investigators hypothesized that patients from safety-net hospitals, hospitals that care for low-income, uninsured, vulnerable populations, are more likely to not follow up with their active surveillance care than patients at university hospitals.

The authors compared the rates of active surveillance patients being lost to follow-up at Los Angeles County Hospital (a safety-net hospital) to those at the USC Norris Comprehensive Cancer Center. The study included 116 patients from Los Angeles County Hospital and 90 patients from USC Norris. Patients at both hospitals had similar tumor characteristics, but differed in median income, race, primary language spoken, median miles from the hospital, and mean percent that graduated from a high school in their zip code.

The investigators found a significant difference between the 2 centers, with 48% of patients at Los Angeles County Hospital lost to follow-up and only 16% at USC Norris lost to follow-up. The median amount of time spent on active surveillance at Los Angeles County Hospital was 7.4 months compared to 22.8 months at USC Norris.

Patients at USC Norris were more likely to be lost to follow-up if they had a low household income. Patients that lived a further distance from Los Angeles County Hospital were more likely to abide to their active surveillance schedule. The investigators conclude, “We need further investigation to evaluate whether we should recommend active surveillance at safety-net hospitals.”


1. Kraus R, Ji L, Jennelle R, et. al. Active surveillance: do low-income patients adhere to the protocol? Poster presented at: 2017 Genitourinary Cancers Symposium; February 16-18, 2017; Orlando, FL. Abstract 53.

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