Immediate treatment vs. active-surveillance in very-low-risk prostate cancer: the role of patient-, tumour-, and hospital-related factors.

Autor: Jansen H; Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands. hannekejansen@gmail.com., van Oort IM; Department of Urology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands., van Andel G; Department of Urology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands., Wijsman BP; Department of Urology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands., Pos FJ; Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Hulshof MCCM; Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands., Hulsbergen-van de Kaa CA; Department of Pathology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands., van Leenders GJLH; Department of Pathology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands., Fütterer JJ; Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands., Somford DM; Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands., Busstra MB; Department of Urology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands., van Moorselaar RJA; Department of Urology, VU University Medical Center, Amsterdam, The Netherlands., Kiemeney LA; Department of Urology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.; Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands., Aben KKH; Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.; Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
Jazyk: angličtina
Zdroj: Prostate cancer and prostatic diseases [Prostate Cancer Prostatic Dis] 2019 May; Vol. 22 (2), pp. 337-343. Date of Electronic Publication: 2018 Nov 14.
DOI: 10.1038/s41391-018-0109-y
Abstrakt: Background: To provide insight in the treatment variation of very-low-risk prostate cancer patients and to assess the role of hospital-related factors.
Methods: All patients diagnosed with very-low-risk prostate cancer (cT1c-cT2a, PSA < 10 ng/ml, Gleason score <7 and <3 positive cores) in 2015 and 2016 were identified through the population-based Netherlands Cancer Registry. Multilevel logistic regression analyses were performed to examine the crude and case-mix adjusted probability of immediate treatment vs. active-surveillance (AS) according to hospital of diagnosis and to evaluate the effect of patient-, tumour-, and hospital-related factors.
Results: In all, 2047 (85.4%) of the 2396 patients with very-low-risk prostate cancer were managed with AS. The crude proportion of patients with AS varied from 33.3 to 100% between hospitals. Case-mix adjusted probability varied from 71 to 97%. Tumour stage cT2a vs. cT1c (OR 2.0, 95%CI 1.1-3.6), two vs. one positive core (OR 2.8, 95%CI 1.6-4.7), diagnostic MRI (OR 2.8, 95%CI 1.5-5.2), discussion of a patient in a multi-disciplinary team (OR 2.2, 95%CI 1.1-4.5), discussion of treatment options with the patient (OR 3.3, 95%CI 1.5-7.4) and type of hospital (non-university referral hospital vs. community hospital: OR 0.5, 95%CI 0.2-0.9) were associated with immediate treatment.
Conclusion: The majority of Dutch very-low-risk prostate cancer patients is managed with AS but variation between hospitals exists. Part of the variation is explained by patient- and tumour characteristics but also hospital-related factors play a role. This implies that clinical practice could be improved.
Databáze: MEDLINE
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