OBJECTIVES: To ascertain the treatment trends and patterns of care, for men with prostate cancer (PC) on Active Surveillance (AS) in Victoria, Australia.
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MATERIAL AND METHODS: De-identified data was obtained for 6424 men from the PCR. Men included in this study were diagnosed with prostate cancer from 2008 to August 2012 with a minimum of 12-month follow-up. Patients were stratified using the NCCN risk grouping system and those who were not actively treated were identified. Data was acquired to describe the trends and uptake of AS according to public vs. private hospital sector, and regional vs. metropolitan regions.
RESULTS: A total of 1603/ 6424 (24.9%) of men received no treatment with curative intent at 12 months follow- up. This cohort included patients in whom the chosen management plan was AS (980/1603, 61.1%), watchful waiting (WW- 341/1603, 21.3%), or no management plan (282/1603, 17.6%) was recorded. From this, 980/6424(15.3%) of patients were recorded as being on AS across all NCCN categories at 12 months after diagnosis. This includes 653/1816 (35.9%) of very low and low-risk men, and 251/2820 (8.9%) of intermediate-risk men. Of our patients on AS, 169/980 (17.2%) progressed onto active treatment after 12 months. This was radical prostatectomy in 116 (68.6%), with 32 (18.9%) undergoing external beam radiation therapy (EBRT), 12 (7.1%) undergoing brachytherapy (BT) and 9 (5.3%) undergoing androgen deprivation therapy (ADT). Overall, 629/979 (64.2%) of AS patients were notified from a private hospital, with 350/979 (35.7%) of patients notified from a public hospital (1 patient unclassified). Of these, 202/652 (30.9%) of AS patients with very low/ low risk were managed in the public sector, vs. 450/652 (69%) of very low/ low risk AS patients being managed in the private sector. In our cohort, patients with very low and low risk disease, managed in a private hospital, were more likely to be on AS (p=0.005). AS patients in the private sector were also observed to have a median age 2.8 years younger (65.6 vs. 68.4, p< 0.001); lower median PSA (5.3 vs. 6.7, p< 0.001); have lower biopsy Gleason score and clinical staging. There was no significant difference in the uptake of AS demographically, in our cohort of men, between metropolitan and regional areas.
CONCLUSION: In this contemporary Registry-based population, AS is being used in a significant proportion of patients. The proportion of men progressing to intervention is lower than what is shown in current literature. Patients are more likely to be on AS if they are managed in a private hospital, with no differences in the uptake of AS, from metropolitan to regional areas.
Weerakoon M, Papa N, Lawrentschuk N, Evans S, Millar J, Frydenberg M, Bolton D, Murphy DG. Are you the author?
Epworth Prostate Centre, Epworth Healthcare, Richmond, Australia; University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia; School of Epidemiology and Public Health, Alfred Hospital, Monash University, Melbourne, Australia; University of Melbourne, Peter MacCallum Cancer Centre, East Melbourne, Australia.
Reference: BJU Int. 2015 Jan 19. Epub ahead of print.