MUSIC to the ears of advocates for active surveillance

A new paper from the coordinators of the Michigan Urological Surgery Improvement Collaborative (MUSIC) suggests that as many as 50 percent of newly diagnosed patients with low-risk forms of prostate cancer in Michigan are now receiving initial management on active surveillance (AS). This should be compared to historical rates of initial surveillance that were between 4 and 20 percent.

Womble et al. carried out a prospective study of men with low-risk prostate cancer being managed by urologists at 17 practices in Michigan that participate in the MUSIC initiative. The goal was simple: to assess the contemporary utilization of AS among a population-based sample of men with low-risk prostate cancer.

Key outcome data sought by the investigators included:

  • Receipt of AS as initial management for low-risk prostate cancer
  • Frequency of follow-up using PSA testing, prostate biopsy, and local therapy

The investigators also used claims data to validate treatment classification in the MUSIC registry.

Here are the core study findings:

  • 682 low-risk patients were identified at the 17 MUSIC practices.
    • 49 percent of these patients underwent initial AS.
    • For 8 percent of these patients, the form of their management or treatment was not identifiable.
  • The initial use of AS varied widely across practices (from 27 to 80 percent; p = 0.005).
  • Among patients managed with initial AS and ≥ 12 months of follow-up,
    • 85 percent received PSA testing.
    • Repeat biopsies were performed in only a third of patients.
  • There was excellent agreement between treatment assignments in the MUSIC registry and claims data.

The authors conclude that, as well as being able to see that about half of all the patients with low-risk disease  in Michigan are now being managed initially on active surveillance,

Because this proportion is much higher than reported previously, our findings suggest growing acceptance of this strategy for reducing over-treatment.

As a long-time advocates for careful forms of monitoring as a highly appropriate medical strategy for the management of men with low-risk prostate cancer, The “New” Prostate Cancer InfoLink and Prostate Cancer International are very gratified to see this significant degree of adoption of AS by the urology community in Michigan, and the success of the MUSIC initiative in promoting the use of this strategy to community urologists across the state. Hopefully, others will also be able to learn from what has apparently been accomplished in Michigan over a relatively short time frame.

6 Responses

  1. Did the paper mention how the 17 practices were recruited to participate in the study? Without knowing the details, it seems possible that urologists willing to participate were already using AS. (That is, it was not a random sample and may not represent Michigan as a whole).

  2. This is excellent news.

  3. Doug:

    This was not a randomized study. You can get background and data about the MUSIC initiative if you click here. The group that put the initiative together (several years ago now) has made considerable efforts to ensure that the practice groups that are participating in its activities (which go way beyond this particular study) are representative of the urology groups across the state, but the precise degree to which data from any one study may represent the entire state is difficult to assess.


    The robust percentage of active surveillance reported above is in line with an earlier study reported by Sitemaster. That study indicated a rising trend in the US up to 18.6% in 2011, the last year of the study. The year of this survey is not clear, but in context I’m guessing it was 2012 to 2013.

    About half of “low-risk” men going to AS may be closing in on the ideal approximate percentage. “Low-risk” traditionally involves three factors — PSA, Gleason score, and stage, while AS criteria in the past few years have typically also involved PSA density, percentage of cores positive, and a velocity criterion. Use of the latter three criteria would decrease the percentage of patients deemed appropriate for AS. I am not aware of figures suggesting the impact of the latter three criteria on winnowing the numbers of men deemed good candidates for AS.

    This study is highly encouraging!

  5. There has been a breakthrough in prostate cancer screening which could allow doctors to diagnose the disease much earlier in some cases.

  6. Huh? What breakthrough? And it would only be useful if it was a breakthrough that clearly could distinguish between clinically significant and indolent forms of prostate cancer. I know of no such test that can do this with accuracy.

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