Active surveillance in Canadian men with low-grade prostate cancer

Cristea, Octav; Lavallée, Luke T.; Montroy, Joshua; Stokl, Andrew; Cnossen, Sonya; Mallick, Ranjeeta; Fergusson, Dean; Momoli, Franco; Cagiannos, Illias; Morash, Christopher; Breau, Rodney H.

doi:10.1503/cmaj.150832

Cited by 14 publications

(8 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[12][13][14][15] We pre-viously reported that 67% of men with Gleason 6 cancer at The Ottawa Hospital receive active surveillance, regardless of PSA or clinical stage. 4 This study complements these data by showing that almost all patients who received surgery in Eastern Ontario had clinically significant (Gleason ≥ 7 or stage pT3) disease. Furthermore, the proportion of patients with clinically significant cancer who underwent surgery has increased by 5% per year and continues to rise.…”

Section: Discussionsupporting

confidence: 66%

See 1 more Smart Citation

Reducing overtreatment of prostate cancer by radical prostatectomy in Eastern Ontario: a population-based cohort study

Witherspoon

Lau

Breau

et al. 2018

cmajo

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 66%

“…However, a previous report showed that more patients with low-risk disease in our region are opting for active surveillance, which would suggest that patient selection is the main reason for the changes observed. 4…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Reducing overtreatment of prostate cancer by radical prostatectomy in Eastern Ontario: a population-based cohort study

Witherspoon

Lau

Breau

et al. 2018

cmajo

Self Cite

View full text Add to dashboard Cite

show abstract

“…18,20,23 Assuming that 50% of subject had low-risk disease 15 and that the majority of patients included in our AS group were indeed low-risk, one could postulate that approximately 36% of patients with low-risk disease were treated by this approach during the study period. These rates were similar to those in other population-based studies, which varied from 10-38% 11,[16][17][18][20][21][22] and in line with the recent single-institution series by Cristea et al 24 Differences in study methodology (any-risk cohort vs. low-risk cohort; pooling AS and WW together vs. presenting them separately) and the countries' healthcare systems could explain the divergent rates. Given the similarities of our single-payer healthcare system with that of Sweden, we expected our rates to more closely resemble theirs.…”

Section: Discussionsupporting

confidence: 90%

“…In other areas of PCa management, there are significant differences between Canada and other countries. Although a recent single-institution series from the University of Ottawa has examined the treatment patterns of men diagnosed with low-risk PCa, 24 there remains a need to better understand the rates of AS use and the factors related to its adoption, outside of single-institution series. We hypothesized that the rates of AS increased throughout the study period.…”

mentioning

confidence: 99%

The uptake of active surveillance for the management of prostate cancer: A population-based analysis

Richard

Alibhai²,

Panzarella³

et al. 2016

CUAJ

View full text Add to dashboard Cite

Introduction: Active surveillance (AS) is a strategy for the management of low-risk prostate cancer (PCa). However, few studies have assessed the uptake of AS at a population level and none of these were based on a Canadian population. Therefore, our objectives were to estimate the proportion of men being managed by AS in Ontario and to assess the factors associated with its uptake. Methods: This was a retrospective, population-based study using administrative databases from the province of Ontario to identify men ≤75 years diagnosed with localized PCa between 2002 and 2010. Descriptive statistics were used to estimate the proportion of men managed by AS, whereas mixed models were used to assess the factors associated with the uptake of AS. Results: 45 691 men met our inclusion criteria. Of these, 18% were managed by AS. Over time, the rates of AS increased significantly from 11% to 21% (p<0.001). Older age, residing in an urban centre, being diagnosed in the later years of the study period, having a neighborhood income in the highest quintile, and being managed by urologists were all associated with greater odds of receiving AS. Conclusions: There has been a steady increase in the uptake of AS between 2002 and 2010. However, only 18% of men diagnosed with localized PCa were managed by AS during the study period. The decisions to adopt AS were influenced by several individual and physician characteristics. The data suggest that there is significant opportunity for more widespread adoption of AS. IntroductionSince the introduction of prostate-specific antigen (PSA)-based screening, there has been an increase in the incidence of prostate cancer (PCa).1,2 However, this increase is mostly driven by an increase in the diagnosis of clinically insignificant cancers.3 Thus, the management of PCa has been associated with considerable overtreatment. Active surveillance (AS) has been proposed as a strategy to decrease overtreatment [4][5][6][7][8][9][10] and is now recognized as a management option by a number of evidence-based guidelines. 11-13Although several prospective series have reported on its safety, 4-10 few studies have reported on the uptake of AS at a population level. [14][15][16][17][18][19][20][21][22][23] No previous population-based study has evaluated the proportion of men being managed by AS in Canada. In other areas of PCa management, there are significant differences between Canada and other countries. Although a recent single-institution series from the University of Ottawa has examined the treatment patterns of men diagnosed with low-risk PCa, 24 there remains a need to better understand the rates of AS use and the factors related to its adoption, outside of single-institution series. We hypothesized that the rates of AS increased throughout the study period. Methods ParticipantsThis was an institutional review board-approved, population-based, retrospective study that identified, using administrative databases, men aged 18-75 years who were diagnosed with adenocarcinoma of the prostate betwe...

show abstract

“…Presently, the landscape continues to shift toward managing low-and select intermediate-risk prostate cancers with active surveillance and we have already seen increased use of this approach in Canada over a similar period of time, 11,12 with evidence of its long-term safety 13 and uptake in our national guidelines. 14 Consequently, a reduction in radical prostatectomy and radiotherapy rates has been observed over a similar period of time for low-risk patients.…”

mentioning

confidence: 99%