Reasons for discontinuing active surveillance: Assessment of 21 centres in 12 countries in the Movember GAP3 consortium Journal Article


Authors: Van Hemelrijck, M.; Ji, X.; Helleman, J.; Roobol, M. J.; van der Linden, W.; Nieboer, D.; Bangma, C. H.; Frydenberg, M.; Rannikko, A.; Lee, L. S.; Gnanapragasam, V. J.; Kattan, M. W.; Members of the Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance consortium
Contributors: Ehdaie, B.; Benfante, N.
Article Title: Reasons for discontinuing active surveillance: Assessment of 21 centres in 12 countries in the Movember GAP3 consortium
Abstract: Background: Careful assessment of the reasons for discontinuation of active surveillance (AS) is required for men with prostate cancer (PCa). Objective: Using Movember's Global Action Plan Prostate Cancer Active Surveillance initiative (GAP3) database, we report on reasons for AS discontinuation. Design, setting, and participants: We compared data from 10 296 men on AS from 21 centres across 12 countries. Outcome measurements and statistical analysis: Cumulative incidence methods were used to estimate the cumulative incidence rates of AS discontinuation. Results and limitations: During 5-yr follow-up, 27.5% (95% confidence interval [CI]: 26.4-28.6%) men showed signs of disease progression, 12.8% (95% CI: 12.0-13.6%) converted to active treatment without evidence of progression, 1.7% (95% CI: 1.5-2.0%) continued to watchful waiting, and 1.7% (95% CI: 1.4-2.1%) died from other causes. Of the 7049 men who remained on AS, 2339 had follow-up for >5 yr, 4561 had follow-up for <5 yr, and 149 were lost to follow-up. Cumulative incidence of progression was 27.5% (95% CI: 26.4-28.6%) at 5 yr and 38.2% (95% CI: 36.7-39.9%) at 10 yr. A limitation is that not all centres were included due to limited information on the reason for discontinuation and limited follow-up. Conclusions: Our descriptive analyses of current AS practices worldwide showed that 43.6% of men drop out of AS during 5-yr follow-up, mainly due to signs of disease progression. Improvements in selection tools for AS are thus needed to correctly allocate men with PCa to AS, which will also reduce discontinuation due to conversion to active treatment without evidence of disease progression. Patient summary: Our assessment of a worldwide database of men with prostate cancer (PCa) on active surveillance (AS) shows that 43.6% drop out of AS within 5 yr, mainly due to signs of disease progression. Better tools are needed to select and monitor men with PCa as part of AS. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Keywords: prostate cancer; depression; active surveillance; anxiety; predictors; stage; distress; quality-of-life; men; localized prostate-cancer; discontinuation; worldwide; prias
Journal Title: European Urology
Volume: 75
Issue: 3
ISSN: 0302-2838
Publisher: Elsevier Science, Inc.  
Date Published: 2019-03-01
Start Page: 523
End Page: 531
Language: English
ACCESSION: WOS:000458490100041
DOI: 10.1016/j.eururo.2018.10.025
PROVIDER: wos
PUBMED: 30385049
Notes: Article -- Source: Wos
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MSK Authors
  1. Behfar Ehdaie
    73 Ehdaie