A national questionnaire survey of Japanese urologists on active surveillance for low‐ and intermediate‐risk prostate cancer

Kato, Takuma; Tohi, Yoichiro; Honda, Tomoko; Matsuda, Iori; Osaki, Yu; Naito, Hirohito; Matsuoka, Yuki; Okazoe, Homare; Taoka, Rikiya; Tsunemori, Hiroyuki; Ueda, Nobufumi; Sugimoto, Mikio

doi:10.1111/iju.15102

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…Conversely, low-risk patients with a Gleason score ≤ 6 may be good candidates for AS. Based on a Japanese national survey, approximately 90% of urologists proposed AS for low-risk disease 32 , and the number of AS cases has increased over the past decades in Japan. However, not all physicians (urologists) recommend AS, even for low-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, some patients request treatment even if they have a Gleason score ≤ 6 because they fear disease progression, especially younger patients. Kato et al conducted a national questionnaire survey of Japanese urologists (involving 922 urologists at Japanese Urological Association Teaching Base Hospitals) regarding AS for patients with low-and intermediate-risk prostate cancer 32 and reported that 90.5%, 90%, 39.5%, 48.7%, 15%, and 22% urologists proposed AS for patients in low-risk/no comorbidity, low-risk/with comorbidity, intermediate-risk 3 + 4/no comorbidity, intermediate-risk 3 + 4/with comorbidity, intermediate-risk 4 + 3/no comorbidity, and intermediate-risk 4 + 3/with comorbidity groups, respectively. Therefore, approximately 40% of these urologists proposed AS for intermediate-risk cases.…”

Section: Discussionmentioning

confidence: 99%

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The influence of Gleason score ≤ 6 histology on the outcome of high-risk localized prostate cancer after modern radiotherapy

Yamazaki,

Suzuki,

Masui

et al. 2024

Sci Rep

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We aimed to retrospectively review outcomes in patients with high-risk prostate cancer and a Gleason score ≤ 6 following modern radiotherapy. We analyzed the outcomes of 1374 patients who had undergone modern radiotherapy, comprising a high-risk low grade [HRLG] group (Gleason score ≤ 6; n = 94) and a high-risk high grade [HRHG] group (Gleason score ≥ 7, n = 1125). We included 955 patients who received brachytherapy with or without external beam radio-therapy (EBRT) and 264 who received modern EBRT (intensity-modulated radiotherapy [IMRT] or stereotactic body radiotherapy [SBRT]). At a median follow-up of 60 (2–177) months, actuarial 5-year biochemical failure-free survival rates were 97.8 and 91.8% (p = 0.017), respectively. The frequency of clinical failure in the HRLG group was less than that in the HRHG group (0% vs 5.4%, p = 0.012). The HRLG group had a better 5-year distant metastasis-free survival than the HRHG group (100% vs 96.0%, p = 0.035). As the HRLG group exhibited no clinical failure and better outcomes than the HRHG group, the HRLG group might potentially be classified as a lower-risk group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The influence of Gleason score ≤ 6 histology on the outcome of high-risk localized prostate cancer after modern radiotherapy

Yamazaki,

Suzuki,

Masui

et al. 2024

Sci Rep

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“…3 Presently, the authors aimed to clarify the attitude of Japanese urologists toward AS for lowand intermediate-risk PCa by conducting a national questionnaire survey. 4 Despite the clinical evidence supporting AS for low-risk PCa, what prevents AS from being accepted, especially in Japan? This study may provide insights into this question.In this study, approximately 90% of Japanese urologists considered AS an option for the management of low-risk PCa.…”

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confidence: 99%

Editorial Comment on a national questionnaire survey of Japanese urologists on active surveillance for low‐ and intermediate‐risk prostate cancer

Kishida

2023

Int J of Urology

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Several studies have supported active surveillance (AS) as a valid option for the management of low-risk prostate cancer (PCa) compared to that of definitive therapy regarding survival and quality of life. 1 However, approximately 50% of the patients with low-risk PCa received primary curative therapy in the United States. 2 In Japan, 80% of low-risk patients received definitive therapy. 3 Presently, the authors aimed to clarify the attitude of Japanese urologists toward AS for lowand intermediate-risk PCa by conducting a national questionnaire survey. 4 Despite the clinical evidence supporting AS for low-risk PCa, what prevents AS from being accepted, especially in Japan? This study may provide insights into this question.In this study, approximately 90% of Japanese urologists considered AS an option for the management of low-risk PCa. Why do Japanese patients receive definitive therapy rather than AS? The authors attributed this discrepancy to patients' anxiety about receiving AS. This may be true; however, if patients make their decisions, do they fully understand their disease status and treatment options? Urologists have to present sufficient information about the benefits of AS and the harmfulness of definitive therapy.There may be other reasons for this, such as national character, medical system, and insurance. Conversely, their analysis of the differences between doctors and hospitals is interesting. In this study, more experienced doctors and noncancer-specific hospital doctors were less likely to propose AS for patients. Experienced doctors may be comfortable in presenting some kinds of treatment rather than that of doing nothing. Less experienced doctors may be unconfident in definitive therapy or are more likely to stand with the recent evidence. Doctors in cancer hospitals may strictly follow the evidence or guidelines. These attitudes may lead to differences in the management of low-risk PCa. In this study, some of the doctors may confuse AS with watchful waiting, which is extremely disappointing and misleading for the patient's decision. The decision can be made by the patients themselves, only when they get appropriate informed consent. Urologists must learn more about AS and explain it carefully until the patients can fully understand. Accordingly, if patients selected definitive treatment for low-risk disease, they were not overtreated.More acceptance of AS by urologists and radiation oncologists have been demonstrated in the United States. 5 In Japan, more efforts are needed for AS to become accepted as the appropriate management for low-risk PCa.

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“…In this issue of the International Journal of Urology , the authors, using a national questionnaire survey conducted between December 2021 and January 2022, demonstrated that 90% of Japanese urologists proposed AS for low‐risk cases with or without comorbidity 4 . Furthermore, they reported that about 40% of urologists considered AS for favorable intermediate‐risk patients.…”

mentioning

confidence: 99%

Editorial Comment to “A national questionnaire survey of Japanese urologists on active surveillance for low‐ and intermediate‐risk prostate cancer”

Matsumoto

2022

Int J of Urology

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A national questionnaire survey of Japanese urologists on active surveillance for low‐ and intermediate‐risk prostate cancer

Abstract: AbbreviationsAS = active surveillance DRE = digital rectal examination GS = Gleason score HIFU = high-intensity focused ultrasound IMRT = intensity modulated radiation therapy MRI = magnetic resonance imaging PCa = prostate cancer PS = performance status PSA = prostate-specific antigen

Cited by 5 publications

References 20 publications

The influence of Gleason score ≤ 6 histology on the outcome of high-risk localized prostate cancer after modern radiotherapy

The influence of Gleason score ≤ 6 histology on the outcome of high-risk localized prostate cancer after modern radiotherapy

Editorial Comment on a national questionnaire survey of Japanese urologists on active surveillance for low‐ and intermediate‐risk prostate cancer

Editorial Comment to “A national questionnaire survey of Japanese urologists on active surveillance for low‐ and intermediate‐risk prostate cancer”

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