The authors utilized the US National Cancer Data Base (NCDB) to identify 40,215 men with low-risk prostate cancer between 2012-2013 according to the National Comprehensive Cancer Network (NCCN) guidelines. During this time period, the overall rate of AS was 14%. When compared to Comprehensive Community Cancer Centers, patients treated at Community Cancer Programs (OR 2.74, 95%CI 1.94-3.88) and academic institutions (OR 2.50, 95%CI 1.77-3.54) had greater odds of receiving AS. Similarly, patients treated at very high volume facilities had higher odds of receiving AS compared to very low volume institutions (OR 3.50, 95%CI 1.84-6.68). Patient level and hospital level variables accounted for 41% of the variation in receipt of AS, while institution level factors accounted for 35% of variability.
At NCDB institutions in the United States, AS rates remain dismally low for patients with low risk prostate cancer. Compared to a recent study from Sweden , where the current utilization for AS for very low risk patients is 91% and 74% for low-risk patients, there is substantial room for improvement. Since academic and high volume prostate cancer centers seem to have improved utilization in the US, perhaps further education of community-level hospitals is necessary to increase AS rates and prevent overtreatment of disease that is highly unlikely to be life threatening.
1. Loeb S, Folkvaljon Y, Curnyn C, et al. Uptake of Active Surveillance for very-low-risk Prostate Cancer in Sweden. JAMA Oncol 2016 Oct 20 [Epub ahead of print].
Speaker(s): Bjorn Loppenberg, Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, USA
Co-Authors: D. Friedlander, A. Tam, N. Von Landenberg, P. Gild, J. Leow, A. Krasnova, A. Kibel, J. Noldus, M. Menon, M. Sun, Q-D. Trinh
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto
at the #EAU17 - March 24-28, 2017- London, England