PURPOSE: Although the uptake of active surveillance (AS) appears to be increasing in published series, the uptake in most geographic regions remains largely unknown. Our aim was to examine practice patterns around the use of AS in low-risk prostate cancer in Canada. In addition, we examined regional variations in AS uptake, predictors of AS uptake, and persistent use for 12 months. METHODS: This is a retrospective multicentre review of low-risk patients who underwent a prostate biopsy in 2010 in six centres in four provinces (BC, QC, MB and ON). AS was identified based on chart review and required a minimum of 6 months of follow-up after diagnosis without any active treatment. RESULTS: Of 986 patients, 781 patients (mean age 64 years) were incident cases and over three-quarters (77.3 %) chose AS at diagnosis. There were significant differences in uptake of AS by centre (range 65.0-98.0 %, p ≤ 0.05). Key multivariate predictors of pursuing AS included older age (OR 1.34, p = 0.044), centre (p = 0.021), lower number of cores (OR 1.09, p = 0.025), lower number of positive biopsy cores (OR 0.52, p < 0.001), and lower percent core involvement (OR 0.84, p < 0.001). In total, 516 (85.4 %) men remained on AS over 12 months. Maintenance with AS over 12 months differed by centre, ranging from 64.1 to 93.9 % (p = 0.001). Predictors of maintenance with AS over 12 months included older age, centre, and lower number of positive cores. CONCLUSIONS: Active surveillance is widely practiced across Canada, but important regional differences were observed. Further analyses are required to understand the root causes of differences and to determine whether AS uptake is changing over time.
PURPOSE: Although the uptake of active surveillance (AS) appears to be increasing in published series, the uptake in most geographic regions remains largely unknown. Our aim was to examine practice patterns around the use of AS in low-risk prostate cancer in Canada. In addition, we examined regional variations in AS uptake, predictors of AS uptake, and persistent use for 12 months. METHODS: This is a retrospective multicentre review of low-risk patients who underwent a prostate biopsy in 2010 in six centres in four provinces (BC, QC, MB and ON). AS was identified based on chart review and required a minimum of 6 months of follow-up after diagnosis without any active treatment. RESULTS: Of 986 patients, 781 patients (mean age 64 years) were incident cases and over three-quarters (77.3 %) chose AS at diagnosis. There were significant differences in uptake of AS by centre (range 65.0-98.0 %, p ≤ 0.05). Key multivariate predictors of pursuing AS included older age (OR 1.34, p = 0.044), centre (p = 0.021), lower number of cores (OR 1.09, p = 0.025), lower number of positive biopsy cores (OR 0.52, p < 0.001), and lower percent core involvement (OR 0.84, p < 0.001). In total, 516 (85.4 %) men remained on AS over 12 months. Maintenance with AS over 12 months differed by centre, ranging from 64.1 to 93.9 % (p = 0.001). Predictors of maintenance with AS over 12 months included older age, centre, and lower number of positive cores. CONCLUSIONS: Active surveillance is widely practiced across Canada, but important regional differences were observed. Further analyses are required to understand the root causes of differences and to determine whether AS uptake is changing over time.
Entities:
Keywords:
Active surveillance; Population-based study; Prostate cancer; Treatment
Authors: Marc A Dall'Era; Peter C Albertsen; Christopher Bangma; Peter R Carroll; H Ballentine Carter; Matthew R Cooperberg; Stephen J Freedland; Laurence H Klotz; Christopher Parker; Mark S Soloway Journal: Eur Urol Date: 2012-06-07 Impact factor: 20.096
Authors: Pär Stattin; Erik Holmberg; Jan-Erik Johansson; Lars Holmberg; Jan Adolfsson; Jonas Hugosson Journal: J Natl Cancer Inst Date: 2010-06-18 Impact factor: 13.506
Authors: Sigrid Carlsson; Nicole Benfante; Ricardo Alvim; Daniel D Sjoberg; Andrew Vickers; Victor E Reuter; Samson W Fine; Hebert Alberto Vargas; Michal Wiseman; Maha Mamoor; Behfar Ehdaie; Vincent Laudone; Peter Scardino; James Eastham; Karim Touijer Journal: J Urol Date: 2019-12-23 Impact factor: 7.450
Authors: Claire Kim; Frances C Wright; Nicole J Look Hong; Gary Groot; Lucy Helyer; Pamela Meiers; May Lynn Quan; Robin Urquhart; Rebecca Warburton; Anna R Gagliardi Journal: PLoS One Date: 2018-02-05 Impact factor: 3.240
Authors: Margaret Fitch; Kittie Pang; Veronique Ouellet; Carmen Loiselle; Shabbir Alibhai; Simone Chevalier; Darrel E Drachenberg; Antonio Finelli; Jean-Baptiste Lattouf; Simon Sutcliffe; Alan So; Simon Tanguay; Fred Saad; Anne-Marie Mes-Masson Journal: BMC Urol Date: 2017-10-27 Impact factor: 2.264