EAU 2017: Variation in the use of active surveillance for low-risk prostate cancer

London, England (UroToday.com) Despite active surveillance being a standard of care for low-volume, low-risk prostate cancer, its utilization remains low. As overtreatment of prostate cancer remains a significant concern, the underutilization of active surveillance needs to be identified and addressed. The authors of this study utilize the National Cancer Database (NCDB), a large United States cancer database, to evaluate the influence of institutional factors associated with receipt of active surveillance.
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
Full list of variables and effect on AS enrollment:

chart 14

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
Twitter: @tchandra_uromd

at the #EAU17 - March 24-28, 2017- London, England