Active surveillance of men with low risk prostate cancer: evidence from the Prostate Cancer Outcomes Registry - Victoria

Melanie A Evans, Jeremy L Millar, Arul Earnest, Mark Frydenberg, Ian D Davis, Declan G Murphy, Paul Aidan Kearns, Susan M Evans

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: To characterise the practice of active surveillance (AS) for men with low risk prostate cancer by examining the characteristics of those who commence AS, the rate of adherence to accepted AS follow-up protocols over 2 years, and factors associated with good adherence. Design, setting: Retrospective cohort study; analysis of data collected from 38 sites participating in the Prostate Cancer Outcomes RegistryeVictoria. Participants: Men diagnosed with prostate cancer between August 2008 and December 2014 aged 75 years or less at diagnosis, managed by AS for at least 2 years, and with an ISUP grade group of 3 or less (Gleason score no worse than 4 þ 3 ¼ 7). Main outcome measures: Adherence to an AS schedule consisting of at least three PSA measurements and at least one biopsy in the 2 years following diagnosis. Results: Of 1635 men eligible for inclusion in the analysis, 433 (26.5%) adhered to the AS protocol. The significant predictor of adherence in the multivariate model was being diagnosed in a private hospital (v public hospital: adjusted odds ratio [aOR], 1.83; 95% CI, 1.42e2.37; P < 0.001). Significant predictors of nonadherence included being diagnosed by transurethral resection of the prostate (v transrectal ultrasound biopsy [TRUS]: OR, 0.54; 95% CI, 0.39e0.77; P < 0.001) or transperineal biopsy (v TRUS: OR, 0.32; 95% CI, 0.19e0.52; P < 0.001), and being 66 years of age or more at diagnosis (v < 55 years: OR, 0.65; 95% CI, 0.45e0.92; P ¼ 0.015). Conclusion: Almost three-quarters of men who had prostate cancer with low risk of disease progression did not have follow-up investigations consistent with standard AS protocols. The clinical consequences of this shortcoming are unknown.

Original languageEnglish
Pages (from-to)439-443
Number of pages5
JournalMedical Journal of Australia
Volume208
Issue number10
DOIs
Publication statusPublished - 4 Jun 2018

Cite this

@article{4fcefcc61a6f4ba0862b5241ab9b726a,
title = "Active surveillance of men with low risk prostate cancer: evidence from the Prostate Cancer Outcomes Registry - Victoria",
abstract = "Objective: To characterise the practice of active surveillance (AS) for men with low risk prostate cancer by examining the characteristics of those who commence AS, the rate of adherence to accepted AS follow-up protocols over 2 years, and factors associated with good adherence. Design, setting: Retrospective cohort study; analysis of data collected from 38 sites participating in the Prostate Cancer Outcomes RegistryeVictoria. Participants: Men diagnosed with prostate cancer between August 2008 and December 2014 aged 75 years or less at diagnosis, managed by AS for at least 2 years, and with an ISUP grade group of 3 or less (Gleason score no worse than 4 {\th} 3 ¼ 7). Main outcome measures: Adherence to an AS schedule consisting of at least three PSA measurements and at least one biopsy in the 2 years following diagnosis. Results: Of 1635 men eligible for inclusion in the analysis, 433 (26.5{\%}) adhered to the AS protocol. The significant predictor of adherence in the multivariate model was being diagnosed in a private hospital (v public hospital: adjusted odds ratio [aOR], 1.83; 95{\%} CI, 1.42e2.37; P < 0.001). Significant predictors of nonadherence included being diagnosed by transurethral resection of the prostate (v transrectal ultrasound biopsy [TRUS]: OR, 0.54; 95{\%} CI, 0.39e0.77; P < 0.001) or transperineal biopsy (v TRUS: OR, 0.32; 95{\%} CI, 0.19e0.52; P < 0.001), and being 66 years of age or more at diagnosis (v < 55 years: OR, 0.65; 95{\%} CI, 0.45e0.92; P ¼ 0.015). Conclusion: Almost three-quarters of men who had prostate cancer with low risk of disease progression did not have follow-up investigations consistent with standard AS protocols. The clinical consequences of this shortcoming are unknown.",
author = "Evans, {Melanie A} and Millar, {Jeremy L} and Arul Earnest and Mark Frydenberg and Davis, {Ian D} and Murphy, {Declan G} and Kearns, {Paul Aidan} and Evans, {Susan M}",
year = "2018",
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Active surveillance of men with low risk prostate cancer : evidence from the Prostate Cancer Outcomes Registry - Victoria. / Evans, Melanie A; Millar, Jeremy L; Earnest, Arul; Frydenberg, Mark; Davis, Ian D; Murphy, Declan G; Kearns, Paul Aidan; Evans, Susan M.

In: Medical Journal of Australia, Vol. 208, No. 10, 04.06.2018, p. 439-443.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Active surveillance of men with low risk prostate cancer

T2 - evidence from the Prostate Cancer Outcomes Registry - Victoria

AU - Evans, Melanie A

AU - Millar, Jeremy L

AU - Earnest, Arul

AU - Frydenberg, Mark

AU - Davis, Ian D

AU - Murphy, Declan G

AU - Kearns, Paul Aidan

AU - Evans, Susan M

PY - 2018/6/4

Y1 - 2018/6/4

N2 - Objective: To characterise the practice of active surveillance (AS) for men with low risk prostate cancer by examining the characteristics of those who commence AS, the rate of adherence to accepted AS follow-up protocols over 2 years, and factors associated with good adherence. Design, setting: Retrospective cohort study; analysis of data collected from 38 sites participating in the Prostate Cancer Outcomes RegistryeVictoria. Participants: Men diagnosed with prostate cancer between August 2008 and December 2014 aged 75 years or less at diagnosis, managed by AS for at least 2 years, and with an ISUP grade group of 3 or less (Gleason score no worse than 4 þ 3 ¼ 7). Main outcome measures: Adherence to an AS schedule consisting of at least three PSA measurements and at least one biopsy in the 2 years following diagnosis. Results: Of 1635 men eligible for inclusion in the analysis, 433 (26.5%) adhered to the AS protocol. The significant predictor of adherence in the multivariate model was being diagnosed in a private hospital (v public hospital: adjusted odds ratio [aOR], 1.83; 95% CI, 1.42e2.37; P < 0.001). Significant predictors of nonadherence included being diagnosed by transurethral resection of the prostate (v transrectal ultrasound biopsy [TRUS]: OR, 0.54; 95% CI, 0.39e0.77; P < 0.001) or transperineal biopsy (v TRUS: OR, 0.32; 95% CI, 0.19e0.52; P < 0.001), and being 66 years of age or more at diagnosis (v < 55 years: OR, 0.65; 95% CI, 0.45e0.92; P ¼ 0.015). Conclusion: Almost three-quarters of men who had prostate cancer with low risk of disease progression did not have follow-up investigations consistent with standard AS protocols. The clinical consequences of this shortcoming are unknown.

AB - Objective: To characterise the practice of active surveillance (AS) for men with low risk prostate cancer by examining the characteristics of those who commence AS, the rate of adherence to accepted AS follow-up protocols over 2 years, and factors associated with good adherence. Design, setting: Retrospective cohort study; analysis of data collected from 38 sites participating in the Prostate Cancer Outcomes RegistryeVictoria. Participants: Men diagnosed with prostate cancer between August 2008 and December 2014 aged 75 years or less at diagnosis, managed by AS for at least 2 years, and with an ISUP grade group of 3 or less (Gleason score no worse than 4 þ 3 ¼ 7). Main outcome measures: Adherence to an AS schedule consisting of at least three PSA measurements and at least one biopsy in the 2 years following diagnosis. Results: Of 1635 men eligible for inclusion in the analysis, 433 (26.5%) adhered to the AS protocol. The significant predictor of adherence in the multivariate model was being diagnosed in a private hospital (v public hospital: adjusted odds ratio [aOR], 1.83; 95% CI, 1.42e2.37; P < 0.001). Significant predictors of nonadherence included being diagnosed by transurethral resection of the prostate (v transrectal ultrasound biopsy [TRUS]: OR, 0.54; 95% CI, 0.39e0.77; P < 0.001) or transperineal biopsy (v TRUS: OR, 0.32; 95% CI, 0.19e0.52; P < 0.001), and being 66 years of age or more at diagnosis (v < 55 years: OR, 0.65; 95% CI, 0.45e0.92; P ¼ 0.015). Conclusion: Almost three-quarters of men who had prostate cancer with low risk of disease progression did not have follow-up investigations consistent with standard AS protocols. The clinical consequences of this shortcoming are unknown.

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U2 - 10.5694/mja17.00559

DO - 10.5694/mja17.00559

M3 - Article

VL - 208

SP - 439

EP - 443

JO - Medical Journal of Australia

JF - Medical Journal of Australia

SN - 0025-729X

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