Active surveillance for prostate cancer: selection criteria, guidelines, and outcomes

Walker, Colton; Marchetti, Kathryn; Singhal, Udit; Morgan, Todd M

doi:10.1007/s00345-021-03622-8

Cited by 23 publications

(14 citation statements)

References 48 publications

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“…Although academic series have demonstrated the safety and appropriateness of AS for many years, its adoption in community practice in the US, for a variety of reasons, has been slow. Until 2010, the proportion of low-risk disease managed with AS in community practice was consistently less than 10%; during the past decade, this proportion has improved but remained less than 50% .…”

Section: Discussionmentioning

confidence: 99%

Time Trends and Variation in the Use of Active Surveillance for Management of Low-risk Prostate Cancer in the US

et al. 2023

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ImportanceActive surveillance (AS) is endorsed by clinical guidelines as the preferred management strategy for low-risk prostate cancer, but its use in contemporary clinical practice remains incompletely defined.ObjectiveTo characterize trends over time and practice- and practitioner-level variation in the use of AS in a large, national disease registry.Design, Setting, and ParticipantsThis retrospective analysis of a prospective cohort study included men with low-risk prostate cancer, defined as prostate-specific antigen (PSA) less than 10 ng/mL, Gleason grade group 1, and clinical stage T1c or T2a, newly diagnosed between January 1, 2014, and June 1, 2021. Patients were identified in the American Urological Association (AUA) Quality (AQUA) Registry, a large quality reporting registry including data from 1945 urology practitioners at 349 practices across 48 US states and territories, comprising more than 8.5 million unique patients. Data are collected automatically from electronic health record systems at participating practices.ExposuresExposures of interest included patient age, race, and PSA level, as well as urology practice and individual urology practitioners.Main Outcomes and MeasuresThe outcome of interest was the use of AS as primary treatment. Treatment was determined through analysis of electronic health record structured and unstructured clinical data and determination of surveillance based on follow-up testing with at least 1 PSA level remaining greater than 1.0 ng/mL.ResultsA total of 20 809 patients in AQUA were diagnosed with low-risk prostate cancer and had known primary treatment. The median age was 65 (IQR, 59-70) years; 31 (0.1%) were American Indian or Alaska Native; 148 (0.7%) were Asian or Pacific Islander; 1855 (8.9%) were Black; 8351 (40.1%) were White; 169 (0.8%) were of other race or ethnicity; and 10 255 (49.3%) were missing information on race or ethnicity. Rates of AS increased sharply and consistently from 26.5% in 2014 to 59.6% in 2021. However, use of AS varied from 4.0% to 78.0% at the urology practice level and from 0% to 100% at the practitioner level. On multivariable analysis, year of diagnosis was the variable most strongly associated with AS; age, race, and PSA value at diagnosis were all also associated with odds of surveillance.Conclusions and RelevanceThis cohort study of AS rates in the AQUA Registry found that national, community-based rates of AS have increased but remain suboptimal, and wide variation persists across practices and practitioners. Continued progress on this critical quality indicator is essential to minimize overtreatment of low-risk prostate cancer and by extension to improve the benefit-to-harm ratio of national prostate cancer early detection efforts.

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Section: Discussionmentioning

confidence: 99%

Time Trends and Variation in the Use of Active Surveillance for Management of Low-risk Prostate Cancer in the US

et al. 2023

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“…Active surveillance is considered an alternative for patients with low-risk prostate cancer. Overtreatment of this group of patients leads to important physical, mental, and economic burden which can be avoided with careful monitoring of this subgroup of patients [25][26][27][28][29]. Klotz et al in the pre mpMRI era initially reported the results of a prospective trial of 450 patients who underwent active surveillance describing an overall survival of 78.6% for patients opting for this treatment strategy with a median follow-up of 6.8 years [30].…”

Section: Role Of Mri In Active Surveillancementioning

confidence: 99%

MRI and Targeted Biopsy Essential Tools for an Accurate Diagnosis and Treatment Decision Making in Prostate Cancer

et al. 2021

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Prostate cancer (PCa) is one of the most frequent causes of cancer death worldwide. Historically, diagnosis was based on physical examination, transrectal (TRUS) images, and TRUS biopsy resulting in overdiagnosis and overtreatment. Recently magnetic resonance imaging (MRI) has been identified as an evolving tool in terms of diagnosis, staging, treatment decision, and follow-up. In this review we provide the key studies and concepts of MRI as a promising tool in the diagnosis and management of prostate cancer in the general population and in challenging scenarios, such as anteriorly located lesions, enlarged prostates determining extracapsular extension and seminal vesicle invasion, and prior negative biopsy and the future role of MRI in association with artificial intelligence (AI).

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“…During AS, biopsies are taken to monitor the disease and detect progression. However, current AS cohorts employ different biopsy intervals since there is no consensus so far 7 . For instance, the Johns Hopkins cohort requires annual biopsies for the participants, 8 and the Prostate Cancer Active Surveillance Study (PASS) protocol calls for annual biopsies in the first 2 years and afterwards biennially 9 .…”

Section: Introductionmentioning

confidence: 99%

Exploring the relation of active surveillance schedules and prostate cancer mortality

Yang,

Heijnsdijk,

Newcomb

et al. 2024

Cancer Medicine

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BackgroundActive surveillance (AS), where treatment is deferred until cancer progression is detected by a biopsy, is acknowledged as a way to reduce overtreatment in prostate cancer. However, a consensus on the frequency of taking biopsies while in AS is lacking. In former studies to optimize biopsy schedules, the delay in progression detection was taken as an evaluation indicator and believed to be associated with the long‐term outcome, prostate cancer mortality. Nevertheless, this relation was never investigated in empirical data. Here, we use simulated data from a microsimulation model to fill this knowledge gap.MethodsIn this study, the established MIcrosimulation SCreening Analysis model was extended with functionality to simulate the AS procedures. The biopsy sensitivity in the model was calibrated on the Canary Prostate Cancer Active Surveillance Study (PASS) data, and four (tri‐yearly, bi‐yearly, PASS, and yearly) AS programs were simulated. The relation between detection delay and prostate cancer mortality was investigated by Cox models.ResultsThe biopsy sensitivity of progression detection was found to be 50%. The Cox models show a positive relation between a longer detection delay and a higher risk of prostate cancer death. A 2‐year delay resulted in a prostate cancer death risk of 2.46%–2.69% 5 years after progression detection and a 10‐year risk of 5.75%–5.91%. A 4‐year delay led to an approximately 8% greater 5‐year risk and an approximately 25% greater 10‐year risk.ConclusionThe detection delay is confirmed as a surrogate for prostate cancer mortality. A cut‐off for a “safe” detection delay could not be identified.

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Active surveillance for prostate cancer: selection criteria, guidelines, and outcomes

Cited by 23 publications

References 48 publications

Time Trends and Variation in the Use of Active Surveillance for Management of Low-risk Prostate Cancer in the US

Time Trends and Variation in the Use of Active Surveillance for Management of Low-risk Prostate Cancer in the US

MRI and Targeted Biopsy Essential Tools for an Accurate Diagnosis and Treatment Decision Making in Prostate Cancer

Exploring the relation of active surveillance schedules and prostate cancer mortality

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