Wee Loon Ong1, Sue M Evans2, Melanie Evans2, Mark Tacey3, Lachlan Dodds4, Paul Kearns5, Roger L Milne6, Farshad Foroudi7, Jeremy Millar8. 1. Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Australia; School of Clinical Medicine, University of Cambridge, Cambridge, UK; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Health and Biomedical Informatics Centre, University of Melbourne, Melbourne, Australia. Electronic address: weeloonong@cantab.net. 2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. 3. Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Australia; Department of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Australia. 4. Ballarat Health Services, Ballarat, Australia. 5. Barwon Health, Geelong, Australia. 6. Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia; Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia; Precision Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Australia. 7. Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Australia. 8. Alfred Health Radiation Oncology Services, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia.
Abstract
Conservative management, specifically with active surveillance (AS), has emerged as the preferred approach for low-risk prostate cancer (LRPC). We evaluated the trend for conservative management (ie, no active treatment within 12mo of diagnosis) for LRPC in an Australian population-based cohort of men captured in the Prostate Cancer Outcomes Registry Victoria (PCOR-Vic). Of the 3201 men diagnosed with LRPC between January 2009 and December 2016, 60% (1928/3201) had conservative management, and 52% (1664/3201) were documented to be on AS. There was an increase in conservative management from 52% in 2009 to 73% in 2016 (p<0.001), largely attributable to an increase in AS from 33% in 2009 to 67% in 2016 (p<0.001). When stratified by age group, the increase in conservative management was more pronounced among younger patients: from 37% to 66% for men aged <60yr versus from 72% to 86% for men aged ≥70yr. In multivariable analyses, increasing age, lower prostate-specific antigen and clinical category, lower socioeconomic status, and being diagnosed in public metropolitan institutions were all independently associated with a greater likelihood of conservative management. Identification of sociodemographic and institutional variations in practice allows for targeted strategies to improve management for men with LRPC. PATIENT SUMMARY: We looked at the uptake of conservative management (no active treatment within 12 mo of diagnosis) over time in an Australian population-based cohort of men with low-risk prostate cancer. The proportion of men with low-risk prostate cancer managed conservatively increased from 52% in 2009 to 73% in 2016. The increase in the uptake of conservative management for low-risk prostate cancer in Australia is concordant with international guidelines and other international population-based studies.
Conservative management, specifically with active surveillance (AS), has emerged as the preferred approach for low-risk prostate cancer (LRPC). We evaluated the trend for conservative management (ie, no active treatment within 12mo of diagnosis) for LRPC in an Australian population-based cohort of men captured in the Prostate Cancer Outcomes Registry Victoria (PCOR-Vic). Of the 3201 men diagnosed with LRPC between January 2009 and December 2016, 60% (1928/3201) had conservative management, and 52% (1664/3201) were documented to be on AS. There was an increase in conservative management from 52% in 2009 to 73% in 2016 (p<0.001), largely attributable to an increase in AS from 33% in 2009 to 67% in 2016 (p<0.001). When stratified by age group, the increase in conservative management was more pronounced among younger patients: from 37% to 66% for men aged <60yr versus from 72% to 86% for men aged ≥70yr. In multivariable analyses, increasing age, lower prostate-specific antigen and clinical category, lower socioeconomic status, and being diagnosed in public metropolitan institutions were all independently associated with a greater likelihood of conservative management. Identification of sociodemographic and institutional variations in practice allows for targeted strategies to improve management for men with LRPC. PATIENT SUMMARY: We looked at the uptake of conservative management (no active treatment within 12 mo of diagnosis) over time in an Australian population-based cohort of men with low-risk prostate cancer. The proportion of men with low-risk prostate cancer managed conservatively increased from 52% in 2009 to 73% in 2016. The increase in the uptake of conservative management for low-risk prostate cancer in Australia is concordant with international guidelines and other international population-based studies.
Authors: Zachary Blood; Anh Tran; Lauren Caleo; Robyn Saw; Mbathio Dieng; Mark Shackleton; H Peter Soyer; Chris Arnold; Graham J Mann; Rachael L Morton Journal: BMJ Open Date: 2021-02-11 Impact factor: 2.692
Authors: Tristan Barrett; Simon Pacey; Kelly Leonard; Jerome Wulff; Ionut-Gabriel Funingana; Vincent Gnanapragasam Journal: Eur Urol Open Sci Date: 2022-02-10
Authors: Wee Loon Ong; Isaac Thangasamy; Declan Murphy; Elizabeth Pritchard; Susan Evans; Jeremy Millar; Venu Chalasani; Prem Rashid; Matthew Winter; Ian Vela; David Pryor; Stephen Mark; Nathan Lawrentschuk Journal: BJU Int Date: 2022-02-21 Impact factor: 5.969
Authors: Wee Loon Ong; Norah Finn; Luc Te Marvelde; Colin Hornby; Roger L Milne; Gerard G Hanna; Graham Pitson; Hany Elsaleh; Jeremy L Millar; Farshad Foroudi Journal: J Med Imaging Radiat Oncol Date: 2022-03-31 Impact factor: 1.667
Authors: David I Pryor; Jarad M Martin; Jeremy L Millar; Heather Day; Wee Loon Ong; Marketa Skala; Liesel M FitzGerald; Benjamin Hindson; Braden Higgs; Michael E O'Callaghan; Farhan Syed; Amy J Hayden; Sandra L Turner; Nathan Papa Journal: JAMA Netw Open Date: 2021-11-01