Active surveillance uptake driven by urologists’ recommendations

Data from a recent study published in the journal Cancer show that urologist recommendations, as well as several other patient decisional and psychological factors, influence the initial decision-making regarding active surveillance among patients who have been newly diagnosed with low-risk prostate cancer.^1,2

"Our study findings shed new light on potentially modifiable factors that can help further increase active surveillance use among patients with newly diagnosed low-risk prostate cancer to avoid unnecessary invasive treatment and improve their quality of life,” says Jinping Xu, MD, MS, FAAFP.

In total, the study included data on 1688 Black and White patients who were identified through the metro-Detroit, Michigan, and Georgia cancer registries and who had received a new diagnosis of low-risk prostate cancer from 2014 to 2017. All patients included in the study were 75 years of age or younger.

Among all patients, 57% chose active surveillance over definitive treatment with surgery or radiation. Those who chose active surveillance represented 51% of Black patients and 61% of White patients.

The strongest determinant for choosing active surveillance was a urologist’s recommendation (adjusted prevalence ratio, 6.59; 95% CI, 4.84–8.97). Other factors that influenced a patient’s decision to choose active surveillance included a shared patient-physician treatment decision, greater knowledge of prostate cancer, and residence in the metro-Detroit area compared with Georgia.

Upon unadjusted analysis, older age, White race, and higher education were also associated with initial active surveillance uptake. However, none of these factors remained significant predictors of active surveillance uptake when adjustments were made for covariates.

Patients were less likely to choose active surveillance when their decision was influenced by their treatment goals of achieving “cure” or to “live longer,” or when they perceived their diagnosis of low-risk prostate cancer to be more serious.

“I am glad to see that the majority of our study participants selected active surveillance, which indicates that acceptance has improved over the last decade; however, there is room for greater acceptance. Our study findings shed new light on potentially modifiable factors that can help further increase active surveillance use among patients with newly diagnosed low-risk prostate cancer to avoid unnecessary invasive treatment and improve their quality of life,” concluded lead author Jinping Xu, MD, MS, FAAFP, in a news release on the findings.² Xuis a professor and chairin the department of family medicine and public health sciences at Wayne State University School of Medicine in Detroit, Michigan.

According to the news release, education and interventions for patients and urologists to address these factors may serve as a way to increase active surveillance uptake in the low-risk prostate cancer setting.

References

1. Xu J, Bock CH, Janisse J, et al. Determinants of active surveillance uptake in a diverse population-based cohort of men with low-risk prostate cancer: The Treatment Options in Prostate Cancer Study (TOPCS). Cancer. 2024. doi:10.1002/cncr.35190

2. What factors affect patients’ decisions regarding active surveillance for low-risk prostate cancer? News release. Wiley. January 22, 2024. Accessed January 23, 2024. https://www.newswise.com/articles/what-factors-affect-patients-decisions-regarding-active-surveillance-for-low-risk-prostate-cancer