Time trends for the use of active surveillance and deferred treatment for localised prostate cancer in Sweden: a nationwide study
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View abstract on PubMed
Summary
This summary is machine-generated.Active surveillance (AS) for prostate cancer significantly increased from 2008-2020, especially in younger, healthier men. Deferred treatment rates remained stable, indicating growing acceptance of AS for favorable-risk prostate cancer.
Area Of Science
- Urology
- Oncology
- Public Health
Background
- Active surveillance (AS) is a recommended management strategy for low-risk and select favorable intermediate-risk prostate cancers.
- Evolving clinical guidelines and practice patterns necessitate an understanding of trends in AS adoption and deferred treatment.
- Assessing these trends is crucial for optimizing prostate cancer care pathways.
Purpose Of The Study
- To evaluate temporal trends in the utilization of active surveillance (AS) for localized prostate cancer.
- To examine changes in the proportion of men receiving deferred treatment over time.
- To analyze AS and deferred treatment trends in specific subgroups, including younger men with no comorbidities.
Main Methods
- A nationwide Swedish registry study analyzed 76,191 men diagnosed with low- or intermediate-risk localized prostate cancer between 2008 and 2020.
- The study calculated the proportion of men initiating AS, their clinical characteristics, and the rates of deferred treatment.
- Cox regression models were employed to determine hazard ratios for deferred treatment, with subgroup analyses for men under 60 with a Charlson Comorbidity Index of 0.
Main Results
- The overall use of AS increased substantially from 2008-2010 to 2017-2020 (e.g., any low-risk: 40% to 81%).
- AS adoption rose significantly in younger, healthier men (<60 years, CCI 0), mirroring or exceeding overall trends.
- Crude deferred treatment proportions remained stable (e.g., intermediate-risk: 23% in 2017-2020), but adjusted analyses showed a decrease for very low-risk and an increase for intermediate-risk disease within two years.
Conclusions
- Active surveillance for localized, favorable-risk prostate cancer has seen a marked increase in adoption over the study period.
- This trend is particularly evident in younger, healthier patient populations.
- Deferred treatment rates have been relatively stable, suggesting AS is increasingly recognized as a safe management option.
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