Despite National Comprehensive Cancer Network (NCCN) guidelines that recommend active surveillance (AS) for men with very low-risk prostate cancer, overall use of AS, although increasing, remains low, investigators reported online in Cancer Medicine.
In a study of 2010–2013 data from the National Cancer Data Base (NCDB), Rahul R. Parikh, MD, of the Rutgers Cancer Institute of New Jersey in New Brunswick, and colleagues found that only 14.2% of men with very low-risk prostate cancer (PCa) were managed with AS. They identified a rising trend, however, with the proportion of men placed on AS increasing from 11.6% in 2010 to 27.3% in 2013.
For the study, the researchers identified men with biopsy-proven very low-risk PCa as defined by Epstein criteria (stage T1c or less disease, Gleason score of 6 or less, PSA less than 10 ng/mL, and 2 or fewer [or less than 33%] positive biopsy cores). Of 448,773 patients in the NCDB, 40,838 patients met these criteria. AS was prescribed for 5798 of them. Among patients who opted for treatment, 52.2% underwent radical prostatectomy.
In multivariable analysis, older patients and those without insurance were more likely to be managed with AS compared with younger patients and those with insurance, respectively. Patients were more likely to be placed on AS if they received care at an academic/research center rather than another type of facility.
“In this study, we found low rates of utilization of AS in a conservatively-defined cohort of very low-risk prostate cancer patients,” Dr Parikh’s team wrote. “With concerns of over-diagnosis and over-treatment of prostate cancer, the current national guidelines suggest that patients who meet appropriate criteria should undergo AS with conversion to curative treatment at evidence of progression (NCCN Guidelines V 2.2017).”
Parikh RR, Kim S, Stein MN, et al. Trends in active surveillance for very low-risk prostate cancer: do guidelines influence modern practice. Cancer Med. 2017; published online ahead of print. doi: 10.1002/cam4.1132