Determinants of active surveillance adoption in a diverse population-based cohort of men with low-risk prostate cancer: Treatment Options in Prostate Cancer Study (TOPCS)
Background
Active surveillance ( AS) is the preferred strategy for low-risk prostate cancer (LRPC); however, limited data exist on the determinants of AS adoption, particularly among Black men.
Methods
Newly diagnosed white and black patients (from January 2014 to June 2017) with LRPC ≤75 years of age were identified through population-based cancer registries in metropolitan Detroit and Georgia and completed a survey assessing factors influencing in the adoption of active surveillance (AS).
Results
Among 1,688 study participants, 57% chose active surveillance (AS) (51% black participants, 61% white participants) over definitive treatment. In the unadjusted analysis, patient factors associated with initial AS adoption included older age, white race, and higher education.
However, after adjusting for covariates, none of these factors were significant predictors of AS adoption. The strongest determinant of active surveillance (AS) acceptance was recommendation by a urologist (adjusted prevalence ratio, 6.59; 95% CI, 4.84–8.97).
Other factors associated with the decision to undergo active surveillance (AS) included a shared treatment decision between patient and physician, greater knowledge about prostate cancer, and residence in the Detroit metropolitan area compared to Georgia.
In contrast, men whose decision was strongly influenced by the desire to achieve a “cure” or “live longer” with treatment and those who perceived their low-risk prostate cancer (LRPC) diagnosis as more serious were less likely to choose AS.
Conclusions In this contemporary sample, the majority of patients with newly diagnosed low-risk prostate cancer (LRPC) elected active surveillance (AS). Although the input of their urologists was highly influential, several patient psychological and decision factors were independently associated with acceptance of active surveillance (AS). These data shed new light on potentially modifiable factors that may help further increase AS uptake among patients with LRPC. |
Comments
Urologists’ recommendations and patients’ perception of the severity of cancer have a strong influence.
Because low-risk prostate cancer is unlikely to spread or affect survival, experts and guidelines recommend active surveillance , which involves regular monitoring and therefore avoiding or delaying treatments such as surgery or Radiotherapy and its life-changing complications.
A new study examined rates of active surveillance use and evaluated factors associated with selecting this management strategy over surgery or radiation, focusing on underserved black patients who have been underrepresented in previous studies. The findings were published in CANCER , a peer-reviewed journal of the American Cancer Society.
For the study, called the Prostate Cancer Treatment Options Study, Dr. Jinping Xu, MS, of Wayne State University, and colleagues analyzed data from cancer registries in metropolitan Detroit, Michigan, and Georgia. , focusing on patient self-reported information related to white and black patients who were newly diagnosed with low-risk prostate cancer in 2014-2017.
Among 1,688 patients, 57% chose active surveillance (51% of black patients and 61% of white patients) over other treatments. After adjusting for other influencing factors, the strongest determinant of active surveillance adoption was a urologist’s recommendation to choose this option.
Other factors related to the decision to undergo active surveillance included a shared treatment decision between doctor and patient and increased knowledge about prostate cancer. Additionally, participants living in the Detroit metropolitan area were more likely to choose active surveillance than those living in Georgia.
In contrast, men were less likely to try active surveillance if their considerations were strongly influenced by the desire to achieve a “cure” or if they expected to “live longer” with treatment, or if they perceived that their prostate cancer diagnosis low risk was more likely. "serious."
Education and interventions for patients and especially urologists that address these factors may increase the use of recommended active surveillance among people with low-risk prostate cancer.
“I am glad to see that the majority of our study participants selected active surveillance , indicating that acceptance has improved over the past decade; however, there is room for greater acceptance. "The findings of our study shed new light on potentially modifiable factors that may help further increase the use of active surveillance among patients with newly diagnosed low-risk prostate cancer to avoid unnecessary invasive treatments and improve their quality of life," he said. Dr. Xu.
