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Analysis of active surveillance uptake for low-risk localized prostate cancer in Canada: a Canadian multi-institutional study

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Abstract

Purpose

Although the uptake of active surveillance (AS) appears to be increasing in published series, the uptake in most geographic regions remains largely unknown. Our aim was to examine practice patterns around the use of AS in low-risk prostate cancer in Canada. In addition, we examined regional variations in AS uptake, predictors of AS uptake, and persistent use for 12 months.

Methods

This is a retrospective multicentre review of low-risk patients who underwent a prostate biopsy in 2010 in six centres in four provinces (BC, QC, MB and ON). AS was identified based on chart review and required a minimum of 6 months of follow-up after diagnosis without any active treatment.

Results

Of 986 patients, 781 patients (mean age 64 years) were incident cases and over three-quarters (77.3 %) chose AS at diagnosis. There were significant differences in uptake of AS by centre (range 65.0–98.0 %, p ≤ 0.05). Key multivariate predictors of pursuing AS included older age (OR 1.34, p = 0.044), centre (p = 0.021), lower number of cores (OR 1.09, p = 0.025), lower number of positive biopsy cores (OR 0.52, p < 0.001), and lower percent core involvement (OR 0.84, p < 0.001). In total, 516 (85.4 %) men remained on AS over 12 months. Maintenance with AS over 12 months differed by centre, ranging from 64.1 to 93.9 % (p = 0.001). Predictors of maintenance with AS over 12 months included older age, centre, and lower number of positive cores.

Conclusions

Active surveillance is widely practiced across Canada, but important regional differences were observed. Further analyses are required to understand the root causes of differences and to determine whether AS uptake is changing over time.

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Acknowledgments

This work was supported by the Terry Fox Research Institute (TFRI) of the Terry Fox Research Institute Translational Cancer Research Project: The Canadian Prostate Cancer Biomarker Network (CPCBN) (Grant #2009-17).

Author’s contribution

N. Timilshina, V. Ouellet, S.M.H. Alibhai, A.M. Mes-Masson, D. Drachenberg, A. Finelli, P. Karakiewicz, H. Lapointe, J.B. Lattouf, A. So, and F. Saad were involved in protocol/project development. N. Timilshina, V. Ouellet, S.M.H. Alibhai, A.M. Mes-Masson, N. Delvoye, H. Lapointe, K. Lynch, J.B. Paradis, P. Sitarik, and F. Saad were involved in data collection or management. N. Timilshina, V. Ouellet, S.M.H. Alibhai, A.M. Mes-Masson, F. Saad, and P. Karakiewicz analysed the data. N. Timilshina, V. Ouellet, S.M.H. Alibhai, A.M. Mes-Masson, N. Delvoye, D. Drachenberg, A. Finelli, M.P. Jammal, P. Karakiewicz, H. Lapointe, J.B. Lattouf, K. Lynch, J.B. Paradis, P. Sitarik, A. So, and F. Saad were involved in manuscript writing/editing.

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Authors and Affiliations

  1. University Health Network, Toronto, ON, Canada

    Narhari Timilshina, Shabbir M. H. Alibhai & Antonio Finelli

  2. Centre hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada

    Pierre Karakiewicz, Jean-Baptiste Lattouf & Fred Saad

  3. Institut du Cancer de Montréal/Centre de recherche du CHUM, Montreal, QC, Canada

    Veronique Ouellet, Anne-Marie Mes-Masson, Nathalie Delvoye, Pierre Karakiewicz, Jean-Baptiste Lattouf & Fred Saad

  4. Centre de Santé et des Services Sociaux de Chicoutimi, Chicoutimi, QC, Canada

    Jean-Benoît Paradis

  5. Centre de Santé et des Services Sociaux de Laval, Laval, QC, Canada

    Marie-Paule Jammal

  6. Manitoba Prostate Center, Winnipeg, MB, Canada

    Darrel Drachenberg, Hélène Lapointe & Paula Sitarik

  7. Vancouver Prostate Center, Vancouver, BC, Canada

    Kenny Lynch & Alan So

Authors
  1. Narhari Timilshina
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  2. Veronique Ouellet
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  3. Shabbir M. H. Alibhai
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  8. Marie-Paule Jammal
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  9. Pierre Karakiewicz
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  10. Hélène Lapointe
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  11. Jean-Baptiste Lattouf
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  12. Kenny Lynch
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  13. Jean-Benoît Paradis
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  15. Alan So
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  16. Fred Saad
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Corresponding author

Correspondence to Fred Saad.

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The authors declare that they have no conflict of interest.

Ethical standards

The design and execution of this project was reviewed and approved by ERB from each participating institutions.

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Timilshina, N., Ouellet, V., Alibhai, S.M.H. et al. Analysis of active surveillance uptake for low-risk localized prostate cancer in Canada: a Canadian multi-institutional study. World J Urol 35, 595–603 (2017). https://doi.org/10.1007/s00345-016-1897-0

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  • DOI: https://doi.org/10.1007/s00345-016-1897-0

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