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    Contemporary Management of Incident Prostate Cancer in Large Community Urology Practices in the United States
    Jeremy B. Shelton, Phil Buffington, Richard Augspurger, Franklin Gaylis, Todd Cohen, Bryan Mehlhaff, Ronald Suh, Timothy J. Bradford, Lorna Kwan, Alec S. Koo, and Neal Shore
    OBJECTIVE To characterize the contemporary management of prostate cancer patients in large community
    practices. The optimal management of incident prostate cancer has changed in the last decades to
    include active surveillance for a large number of men. At the same time, many community practi-
    ces have merged into larger groups. The adoption of evidence-based guidelines is of increasing
    importance, but poorly understood in this newer practice setting. METHODS We conducted a retrospective chart review of men ≤75 years old with very low, low, and interme-
    diate risk incident prostate cancer diagnosed between December 1, 2012 and March 31, 2014, in
    9 geographically distributed large urology practices. We used descriptive statistics and multivari-
    able regression to assess predictors of primary management choice. RESULTS 2029 men were in the study cohort. A majority were white (68.7%). Total of 45.7% had interme-
    was the initial treatment for 74.7% of men with very low risk disease, 43.5% of men with low risk
    disease and 10.8% of men with intermediate risk disease. The probability of choosing surgery vs
    radiation for men with lower and intermediate risk disease was 0.54 (95% confidence interval:
    practices largely followed clinical characteristics, widespread adoption of active surveillance,
    and equal use of surgery and radiation. However, some variation by practice suggested a need
    Elsevier Inc.
    The optimal management of newly diagnosed pros-tate cancer has changed substantially in the last decades to recognize the importance of active sur-veillance (AS) and observation for a large number of men within the biologic spectrum of lower risk (National Comprehensive Cancer Network (NCCN) very low and low risk) prostate cancer.1,2 Multiple studies have exam-ined the initially slow rate of adoption of guideline recom-mendations to offer AS to men with lower risk prostate cancer, though few studies have focused entirely on com-munity (private) practices, and those that have, focused
    From the Department of Urology, UCLA, Los Angeles, CA; the Urology Group, Cincinnati, OH; the Urology Center of Colorado, Denver, CO; the Genesis Healthcare Partners, San Diego, CA; the Carolina Urology Partners, Charlotte, NC; the Oregon Urology Institute, Springfield, OR; the Urology of Indiana, Indianapolis, IN; the Virginia Urology, VA; the Department of Urology, UCLA, the Skyline Urology, Los Angeles, CA; and the Atlantic Urology Clinics, Myrtle Beach, SC