The current use of active surveillance in an Australian cohort of men: a pattern of care analysis from the Victorian Prostate Cancer Registry

Abstract

Objectives: To ascertain the treatment trends and patterns of care, for men with prostate cancer on active surveillance (AS) in Victoria, Australia.

Patients and methods: De-identified data was obtained for 6424 men from the Victorian Prostate Cancer Registry. Men included in this study were diagnosed with prostate cancer from 2008 to August 2012 with ≥ 12-months of follow-up. Patients were stratified using the National Comprehensive Cancer Network (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: In all, 1603/6424 (24.9%) men received no treatment with curative intent at 12-months follow-up. This cohort included patients in whom the chosen management plan was recorded as AS (980/1603, 61.1%), watchful waiting (341/1603, 21.3%), or no management plan (282/1603, 17.6%). From this, 980/6424(15.3%) of the patients were recorded as being on AS across all NCCN categories at 12 months after diagnosis. This included 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 active treatment included radical prostatectomy in 116 (68.6%), 32 (18.9%) undergoing external beam radiation therapy, 12 (7.1%) undergoingt brachytherapy and nine (5.3%) undergoing androgen-deprivation therapy. Overall, 629/979 (64.2%) of the AS patients were notified from a private hospital, with 350/979 (35.7%) of the patients notified from a public hospital (one patient unclassified). Of these, 202/652 (30.9%) of the AS patients with very low-/low-risk disease 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 a median of 2.8 years younger (median 65.6 vs 68.4 years, P < 0.001); had a lower median PSA level (5.3 vs 6.7 ng/mL, P < 0.001); and had 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 that reported in the 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.

Keywords: active surveillance; prostate cancer; prostatectomy; registry.