Researchers in Sweden used the National Prostate Cancer Register of Sweden to identify 11,726 male patients 70 years of age or younger who had been diagnosed with intermediate- to very low-risk prostate cancer between 2003 and 2007 and had completed 5 years of follow up.
Of the 11,726 men identified, 1,729 (15%) elected active surveillance as their primary management strategy. The researchers believe that active surveillance is an underutilized tool in reducing prostate cancer overtreatment and thus looked further into the data from this group of patients.
The researchers determined the probability associated with active surveillance discountinuation over the course of treatment and also used Cox proportional hazard models to identify factors that are associated with discontinuing active surveillance.
The precise reasoning for discontinuing active surveillance were extracted from the medical charts of patients. Of the patients who chose active surveillance as their treatment strategy, 64% remained on active surveillance after 5 years of follow up.
Factors that predicted discountinuation were fewer comorbidites, younger age, higher prostate-specific antigen, more education, and clinical stage T2 disease. Interestingly, marital status was not a factor that predicted discontinuation.
The subset of data that identified a reasoning for discontinuation (86%), 20% indicated patient preferences, 52% indicated PSA progression, 24% indicated biopsy progression, and 3% indicated other reasons. While the majority of men continued active surveillance after 5 years of follow up, approximately 20% of patients discontinued active surveillance for nonbiological reasons.
The researchers indicate that patients need support and counseling in favor of active surveillance continuation in these cases to avoid overtreatment.
In this study, authors want to examine the 5–yr outcomes of AS in a population–based setting. In a population–based setting, the majority of men remained on AS at 5 yr. They calculated the probability of discontinuation of AS over time, and Cox proportional hazards models were used to determine factors associated with discontinuation.