Determinants for choosing and adhering to active surveillance for localised prostate cancer: a nationwide population-based study | BMJ Open

Determinants for choosing and adhering to active surveillance for localised prostate cancer: a nationwide population-based study | BMJ Open:



Determinants for choosing and adhering to active surveillance for localised prostate cancer: a nationwide population-based study

22-28 minutes
































Determinants for choosing and adhering to active surveillance for localised prostate cancer: a nationwide population-based study






  1. Oskar Bergengren1,
  2. Hans Garmo2,
  3. Ola Bratt3,
  4. Lars Holmberg1,
  5. Eva Johansson1,
  6. Anna Bill-Axelson1



Abstract

Objective
Knowledge about factors influencing choice of and adherence to active
surveillance (AS) for prostate cancer (PC) is scarce. We aim to identify
which factors most affected choosing and adhering to AS and to quantify
their relative importance.
Design, setting and participants
In 2015, we sent a questionnaire to all Swedish men aged ≤70 years
registered in the National Prostate Cancer Register of Sweden who were
diagnosed in 2008 with low-risk PC and had undergone prostatectomy,
radiotherapy or started on AS.
Outcome measurements and statistical analysis Logistic regression was used to calculate ORs with 95% CIs for factors potentially affecting choice and adherence to AS.
Results
1288 out of 1720 men (75%) responded, 451 (35%) chose AS and 837 (65%)
underwent curative treatment. Of those starting on AS, 238 (53%)
diverted to treatment within 7 years. Most men (83%) choose AS because
‘My doctor recommended AS’. Factors associated with choosing AS over
treatment were older age (OR 1.81, 95% CI 1.29 to 2.54), a Charlson
Comorbidity Index >2 (OR 1.50, 95% CI 1.06 to 2.13), being
unaccompanied when notified of the cancer diagnosis (OR 1.45, 95% CI
1.11 to 1.89). Men with a higher prostate-specific antigen (PSA) at the
time of diagnosis were less likely to adhere to AS (OR 0.26, 95% CI 0.10
to 0.63). The reason for having treatment after initial AS was ‘the PSA
level was rising’ in 55% and biopsy findings in 36%.
Conclusions
A doctor’s recommendation strongly affects which treatment is chosen
for men with low-risk PC. Rising PSA values were the main factor for
initiating treatment for men on AS. These findings need be considered by
healthcare providers who wish to increase the uptake of and adherence
to AS.
  • prostate disease
  • urological tumours
  • protocols & guidelines
This
is an open access article distributed in accordance with the Creative
Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits
others to distribute, remix, adapt, build upon this work
non-commercially, and license their derivative works on different terms,
provided the original work is properly cited, appropriate credit is
given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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