Factors Influencing Men's Choice of and Adherence to Active Surveillance for Low-risk Prostate Cancer: A Mixed-method Systematic Review

Despite support for active surveillance (AS) as a first treatment choice for men with low-risk prostate cancer (PC), this strategy is largely underutilised.

To systematically review barriers and facilitators to selecting and adhering to AS for low-risk PC.

We searched PsychINFO, PubMed, Medline 2000-now, Embase, CINAHL, and Cochrane Central databases between 2002 and 2017 using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The Purpose, Respondents, Explanation, Findings and Significance (PREFS) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) quality criteria were applied. Forty-seven studies were identified.

Key themes emerged as factors influencing both choice and adherence to AS: (1) patient and tumour factors (age, comorbidities, knowledge, education, socioeconomic status, family history, grade, tumour volume, and fear of progression/side effects); (2) family and social support; (3) provider (speciality, communication, and attitudes); (4) healthcare organisation (geography and type of practice); and (5) health policy (guidelines, year, and awareness).

Many factors influence men's choice and adherence to AS on multiple levels. It is important to learn from the experience of other chronic health conditions as well as from institutions/countries that are making significant headway in appropriately recruiting men to AS protocols, through standardised patient information, clinician education, and nationally agreed guidelines, to ultimately decrease heterogeneity in AS practice.

We reviewed the scientific literature for factors affecting men's choice and adherence to active surveillance (AS) for low-risk prostate cancer. Our findings suggest that the use of AS could be increased by addressing a variety of factors such as information, psychosocial support, clinician education, and standardised guidelines.

European urology. 2018 Mar 26 [Epub ahead of print]

Netty Kinsella, Pär Stattin, Declan Cahill, Christian Brown, Anna Bill-Axelson, Ola Bratt, Sigrid Carlsson, Mieke Van Hemelrijck

Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Department of Urology, The Royal Marsden Hospital, London, UK. Electronic address: ., Department of Surgical Sciences, Uppsala University, Uppsala, Sweden., Department of Urology, The Royal Marsden Hospital, London, UK., Department of Urology, Kings College Hospital, London, UK., Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Sweden., Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Sweden; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.

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