PURPOSE: Prior studies have reported underutilization of deferred treatment (i.e. active surveillance or watchful waiting) for low-risk prostate cancer in the United States.
Our objective was to examine contemporary trends in active surveillance and watchful waiting in the nationwide Swedish prostate cancer registry. We also examined factors associated with selection of deferred management, which might provide insight into the rational diffusion of this important management strategy.
MATERIALS AND METHODS: We identified 57,713 men with very low-risk (T1c, Gleason ≤ 6, PSA < 10 ng/ml, PSA density < 0.20 ng/ml/cc, ≤ 2 positive biopsy cores or < 25% of cores positive), low-risk (T1-T2, Gleason ≤ 6, and PSA < 10), and intermediate-risk prostate cancer (T1-T2, Gleason 7 and/or PSA 10-20) in the Prostate Cancer database Sweden (PCBaSe) from 1998-2011. Subclassification of very low-risk disease, and active surveillance versus watchful waiting was possible beginning in 2007. We examined primary treatment selection by risk group, and used logistic regression to evaluate factors associated with deferred treatment.
RESULTS: Overall, 13,272 (46%) men with low-risk and 8,695 (30%) with intermediate-risk prostate cancer chose deferred treatment. Since 2007, 59%, 41%, and 16% of very low, low and intermediate-risk prostate cancer chose active surveillance. Age was by far the strongest determinant of deferred treatment. Education, marital status and comorbidity were significantly but weakly associated with deferring treatment.
CONCLUSIONS: Deferred treatment for low and intermediate-risk prostate cancer was frequently utilized in Sweden. Dissociating diagnosis from treatment in men with a low risk of progression can decrease the rate of overtreatment.
Written by:
Loeb S, Berglund A, Stattin P. Are you the author?
Department of Urology, New York University, NY, NY, USA.
Reference: J Urol. 2013 May 29. pii: S0022-5347(13)04419-4.
doi: 10.1016/j.juro.2013.05.054
PubMed Abstract
PMID: 23727309
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