THE "NEW" PROSTATE CANCER INFOLINK

To date we have seen very few data on the long-term follow-up of men in the US being initially managed on active surveillance (AS) after diagnosis with prostate cancer out in the “real world” of community urology practice.

A recenly published paper by Shelton et al. has reported data from a study on the 3-year outcomes of a cohort of nearly 500 men, all diagnosed with prostate cancer between January 2013 and May 2104, and all managed over time on active surveillance at one of nine geographically diverse, community-based urology practices here in the US.

This was a retrospective analysis of data from the nine practices, and not data from a prospective study, and so it does need to be treated with some caution.

The study divided patients into three sub-cohorts who met criteria for very low-risk, low-risk, and intermediate-risk prostate cancer as defined by the NCCN in the study time period.

Here are the core findings from the study:

• 548 men met appropriate criteria for initial inclusion in the study.
• 492/548 men (89.8 percent) were actually followed over time at the urology practice where they were initially enrolled.
• The average (median) period of follow-up for the men in the study was 3.35 years.
• 171 patients discontinued AS during the follow-up period.
• Unsurprisingly, discontinuation of active surveillance was significantly associated with increasing NCCN risk classification.
• As compared to men initially diagnosed with very low-risk prostate cancer, discontinuation of AS  was higher among men ninitially diagnosed with
  • Low-risk prostate cancer (hazard ratio [HR] = 1.65; p = 0.02)
  • Intermediate-risk prostate cancer (HR = 2.09, p < 0.01)
• Among men who discontinued AS
  • 47 percent elected surgical treatment
  • 53 percent elected radiation therapy

Shelton et al. conclude that

In this community-based cohort of men on AS, a minority were lost to follow-up and adherence to AS was similar to other reports. Disease characteristics more than sociodemographic characteristics correlated with adherence to AS, while surgery and radiotherapy were utilized equally among those discontinuing AS, both suggesting guideline concordant practice of medicine.

This study seems to tell us little about the precise ways in which these men were managed, or about the actual drivers of the decision to change management from AS to any forms of invasive treatment. However, the conversion of some 30% of the patients from AS to invasive treatment over a period of about three and a half years does seem to be similar to the percentages seen in data from some of the large academic center studies of AS.

What we are again missing is any information about what might have been done proactively to try to maintain appropriate men in this study on AS over time.

Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk | Tagged: active surveillance, AS, community, outcomes, practice |