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

Prostate Cancer and Prostatic Diseases volume 22, pages 337–343 (2019)Cite this article

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Abstract

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.

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Acknowledgements

This work is part of the ProZIB initiative (acronym for: ProstaatkankerZorg In Beeld or Insight into Prostate Cancer Care), which was supported by the Dutch Cancer Society.

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Authors and Affiliations

  1. Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands

    Hanneke Jansen & Katja K. H. Aben

  2. Department of Urology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands

    Inge M. van Oort & Lambertus A. Kiemeney

  3. Department of Urology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    George van Andel

  4. Department of Urology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands

    Bart P. Wijsman

  5. Department of Radiotherapy, The Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Floris J. Pos

  6. Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands

    Maarten C. C. M. Hulshof

  7. Department of Pathology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands

    Christina A. Hulsbergen-van de Kaa

  8. Department of Pathology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

    Geert J. L. H. van Leenders

  9. Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands

    Jurgen.J. Fütterer

  10. Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands

    Diederink M. Somford

  11. Department of Urology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

    Martijn B. Busstra

  12. Department of Urology, VU University Medical Center, Amsterdam, The Netherlands

    Reindert J. A. van Moorselaar

  13. Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands

    Lambertus A. Kiemeney & Katja K. H. Aben

Authors
  1. Hanneke Jansen
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Corresponding author

Correspondence to Hanneke Jansen.

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Conflict of interest

Dr. van Leenders is a consultant for Roche, and has received financial research support of Astra Zeneca and Roche on bladder cancer-related studies. The other authors declare that they have no conflict of interest.

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Jansen, H., van Oort, I.M., van Andel, G. et al. Immediate treatment vs. active-surveillance in very-low-risk prostate cancer: the role of patient-, tumour-, and hospital-related factors. Prostate Cancer Prostatic Dis 22, 337–343 (2019). https://doi.org/10.1038/s41391-018-0109-y

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