TOPLINE:
When provided detailed information on options, most men with low-risk prostate cancer chose active surveillance over treatment, and there was no difference in outcomes, new research from Italy shows.
METHODOLOGY:
- Active surveillance for patients with low-risk prostate cancer has been recommended for years, but its adoption often varies within and between countries.
- The current study, based in Italy, aimed to promote the adoption of active surveillance in two regions in Northern Italy and to understand patient acceptance and outcomes in comparison with active treatment.
- Men newly diagnosed with low-risk prostate cancer between June 2015 and December 2021 were eligible. All were informed of treatment options and were offered active surveillance.
- Multilevel models identified factors associated with choosing active surveillance over active treatment, which consisted of either radical prostatectomy or radiation therapy.
TAKEAWAY:
- Overall, 83% (706 of 852) men chose active surveillance over immediate treatment. There was an upward trend over time, from 78% in 2015-2017 to 90% in 2020-2021.
- Patients who chose active surveillance over any radical treatment were more likely to be aged 75 years or older (odds ratio, 4.27), to have a Charlson Comorbidity Index ≥ 2 (OR, 1.98), to have undergone independent revision of the first biopsy (OR, 2.35), and to have undergone multidisciplinary assessment (OR, 2.65).
- Worse prostate cancer prognostic factors, such as stage T2a (OR, 0.54) and Gleason Score 3+4 (OR, 0.20), were associated with lower odds of choosing active surveillance than any radical treatment.
- In an adjusted intention-to-treat analysis, among patients who initially chose active surveillance, overall survival was not worse in comparison with those who chose any radical treatment (hazard ratio, 0.86; 95% confidence interval, 0.41-1.79) or in comparison with those who chose radical prostatectomy (HR, 0.90; 95% CI, 0.37-2.20).
IN PRACTICE:
“The main remarkable finding of [the trial] is represented by the widespread adoption of active surveillance in our [Regional Oncology Network] since the beginning of the study, and the increasing trend over time, reaching approximately 90% of eligible patients in 2020 to 2021,” the authors wrote.
SOURCE:
The study, with first author Giovannino Ciccone, MD, PhD, AOU City of Health and Science of Turin, Italy, was published online in JAMA Network Open.
LIMITATIONS:
Key limitations include the relatively short follow-up (median, 57 months), variability between centers in terms of enrolling patients and discussing their choices, and the high rate of patients who abandoned active surveillance by year 2 of follow-up. Overall, about 281 patients (~40%) abandoned active surveillance by year 2, most commonly because of biochemical progression.
DISCLOSURES:
The START project was funded by the Fondazione Compagnia di San Paolo and partially by Rete Oncologica del Piemonte e Valle d’Aosta, Turin, Italy. Dr. Ciccone has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.