In this retrospective study, they identified 40,215 men within the NCDB who met criteria for NCCN low-risk prostate cancer. The mean adjusted rate of active surveillance was 14%. Unadjusted proportion of patients eligible for active surveillance ranged from 0% to 100%. The adjusted probability of active surveillance receipt by institution varied from 0% to 53%. Mean adjusted probability of receiving active surveillance was 0.033 (95% confidence interval [CI] 0.023-0.256).
In terms of predictors of receipt of AS, they found that
- Patients in Community Cancer programs and academic institutions were more likely than patients in Comprehensive Community Cancer Centers
- Very-high volume centers were more likely to put patients on AS than low-volume centers
Patient and hospital-level variables accounted for 41% of the overall variation, whereas the treating institution accounted for 35% of the unexplained variability.
Limitations / Discussion Points:
Dr. M. Cooperberg (UCSF) correctly pointed out that the NCDB represents 75% of cancer cases diagnosed in a hospital setting, so it likely underrepresents the true AS enrollment (as most AS occurs in an outpatient setting).
However, the point that AS is under-utilized is well recognized. Institutional changes are required to promote this practice.
Speaker(s): Monique J. Roobol, Department of Urology, Erasmus MC, Rotterdam, The Netherlands
Co-Authors: F. Giganti, A. Kirkham, C. Allen, S. Punwani, M. Emberton, C. Moore
Written By: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto
at the #EAU17 - March 24-28, 2017- London, England