Henrik Olsson1, Tobias Nordström2, Mark Clements3, Henrik Grönberg3, Anna Wallerstedt Lantz4, Martin Eklund3. 1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Electronic address: henrik.olsson@ki.se. 2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences at Danderyd's Hospital, Karolinska Institutet, Sweden. 3. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Karolinska University Hospital Solna, Sweden.
Abstract
BACKGROUND: Active surveillance (AS) is increasingly utilized for low-risk prostate cancers, to delay or avoid treatment. OBJECTIVE: To (1) describe uptake and surveillance intensity of real-world use of AS and compare with national guidelines, and (2) describe transitions from conservative to curative treatment by different indications of disease progression. DESIGN, SETTING, AND PARTICIPANTS: A population-based cohort study of men diagnosed with low-risk prostate cancer, in Stockholm County, Sweden, during 2008-2017. Follow-up was up to 10yr, with a median of 3.5yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Poisson regression was used to estimate incidence rate ratios of prostate-specific antigen (PSA) testing and biopsies. Cox regression was used to estimate hazard ratios of starting curative treatment. RESULTS AND LIMITATIONS: A total of 6021 men with low-risk prostate cancer were included in the analysis; 3116 (52%) had AS recorded as the intended primary management (AS cohort). During 1, 2, and 3yr after diagnosis, the frequencies of at least one PSA test were 90%, 92%, and 88%, respectively, and those of postdiagnostic surveillance biopsies were 42%, 19% and 18%, respectively. During surveillance, 13% of men in the AS cohort were upgraded on rebiopsy, with Gleason upgrading being the strongest factor for starting curative treatment. One limitation is the generalizability to other populations because of differences between surveillance protocols and clinical settings. CONCLUSIONS: Our results show that AS is underutilized and that monitoring differs from current guidelines. Optimization of AS protocols is important in order to increase adherence and avoid overtreatment. PATIENT SUMMARY: Active surveillance has the potential to reduce overtreatment and avoid treatment-related side effects. Our results show that few men receive the recommended monitoring.
BACKGROUND: Active surveillance (AS) is increasingly utilized for low-risk prostate cancers, to delay or avoid treatment. OBJECTIVE: To (1) describe uptake and surveillance intensity of real-world use of AS and compare with national guidelines, and (2) describe transitions from conservative to curative treatment by different indications of disease progression. DESIGN, SETTING, AND PARTICIPANTS: A population-based cohort study of men diagnosed with low-risk prostate cancer, in Stockholm County, Sweden, during 2008-2017. Follow-up was up to 10yr, with a median of 3.5yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Poisson regression was used to estimate incidence rate ratios of prostate-specific antigen (PSA) testing and biopsies. Cox regression was used to estimate hazard ratios of starting curative treatment. RESULTS AND LIMITATIONS: A total of 6021 men with low-risk prostate cancer were included in the analysis; 3116 (52%) had AS recorded as the intended primary management (AS cohort). During 1, 2, and 3yr after diagnosis, the frequencies of at least one PSA test were 90%, 92%, and 88%, respectively, and those of postdiagnostic surveillance biopsies were 42%, 19% and 18%, respectively. During surveillance, 13% of men in the AS cohort were upgraded on rebiopsy, with Gleason upgrading being the strongest factor for starting curative treatment. One limitation is the generalizability to other populations because of differences between surveillance protocols and clinical settings. CONCLUSIONS: Our results show that AS is underutilized and that monitoring differs from current guidelines. Optimization of AS protocols is important in order to increase adherence and avoid overtreatment. PATIENT SUMMARY: Active surveillance has the potential to reduce overtreatment and avoid treatment-related side effects. Our results show that few men receive the recommended monitoring.
Authors: Benjamin H Press; Tashzna Jones; Olamide Olawoyin; Soum D Lokeshwar; Syed N Rahman; Ghazal Khajir; Daniel W Lin; Matthew R Cooperberg; Stacy Loeb; Burcu F Darst; Yingye Zheng; Ronald C Chen; John S Witte; Tyler M Seibert; William J Catalona; Michael S Leapman; Preston C Sprenkle Journal: Eur Urol Open Sci Date: 2022-02-11
Authors: Lars Björnebo; Henrik Olsson; Tobias Nordström; Fredrik Jäderling; Henrik Grönberg; Martin Eklund; Anna Lantz Journal: World J Urol Date: 2020-07-30 Impact factor: 4.226
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Authors: Henrik Olsson; Tobias Nordström; Fredrik Jäderling; Lars Egevad; Hari T Vigneswaran; Magnus Annerstedt; Henrik Grönberg; Martin Eklund; Anna Lantz Journal: J Natl Cancer Inst Date: 2021-05-04 Impact factor: 13.506