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Uptake of Active Surveillance for Very-Low-Risk Prostate Cancer in Sweden

Loeb, Stacy; Folkvaljon, Yasin; Curnyn, Caitlin; Robinson, David; Bratt, Ola LU and Stattin, Pär (2017) In JAMA oncology 3(10). p.1393-1398
Abstract

Importance: Active surveillance is an important option to reduce prostate cancer overtreatment, but it remains underutilized in many countries. Models from the United States show that greater use of active surveillance is important for prostate cancer screening to be cost-effective.

Objectives: To perform an up-to-date, nationwide, population-based study on use of active surveillance for localized prostate cancer in Sweden.

Design, Setting, and Participants: Cross-sectional study in the National Prostate Cancer Register (NPCR) of Sweden from 2009 through 2014. The NPCR has data on 98% of prostate cancers diagnosed in Sweden and has comprehensive linkages to other nationwide databases. Overall, 32 518 men with a median age of... (More)

Importance: Active surveillance is an important option to reduce prostate cancer overtreatment, but it remains underutilized in many countries. Models from the United States show that greater use of active surveillance is important for prostate cancer screening to be cost-effective.

Objectives: To perform an up-to-date, nationwide, population-based study on use of active surveillance for localized prostate cancer in Sweden.

Design, Setting, and Participants: Cross-sectional study in the National Prostate Cancer Register (NPCR) of Sweden from 2009 through 2014. The NPCR has data on 98% of prostate cancers diagnosed in Sweden and has comprehensive linkages to other nationwide databases. Overall, 32 518 men with a median age of 67 years were diagnosed with favorable-risk prostate cancer, including 4693, 15 403, and 17 115 men with very-low-risk (subset of the low-risk group) (clinical stage, T1c; Gleason score, ≤6; prostate-specific antigen [PSA], <10 ng/mL; PSA density <0.15 ng/mL/cm3; and <8-mm total cancer length in ≤4 positive biopsy cores), low-risk (including all men in the very-low-risk group) (T1-T2; Gleason score, ≤6; and PSA, <10 ng/mL), and intermediate-risk disease (T1-T2 with Gleason score, 7 and/or PSA, 10-20 ng/mL).

Exposures: Diagnosis with favorable-risk prostate cancer.

Main Outcomes and Measures: Utilization of active surveillance.

Results: The use of active surveillance increased in men of all ages from 57% (380 of 665) to 91% (939 of 1027) for very-low-risk prostate cancer and from 40% (1159 of 2895) to 74% (1951 of 2644) for low-risk prostate cancer, with the strongest increase occurring from 2011 onward. Among men aged 50 to 59 years, 88% (211 of 240) with very-low-risk and 68% (351 of 518) with low-risk disease chose active surveillance in 2014. Use of active surveillance for intermediate-risk disease remained lower, 19% (561 of 3030) in 2014.

Conclusions and Relevance: Active surveillance has become the dominant management for low-risk prostate cancer among men in Sweden, with the highest rates yet reported and almost complete uptake for very-low-risk cancer. These data should serve as a benchmark to compare the use of active surveillance for favorable-risk disease around the world.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
JAMA oncology
volume
3
issue
10
pages
6 pages
publisher
American Medical Association
external identifiers
  • scopus:85015918653
  • wos:000412879700023
ISSN
2374-2437
DOI
10.1001/jamaoncol.2016.3600
language
English
LU publication?
yes
id
e2889c73-64b6-4f05-a2ef-b1d05e85bf94
date added to LUP
2017-11-28 10:41:52
date last changed
2018-11-18 05:01:03
@article{e2889c73-64b6-4f05-a2ef-b1d05e85bf94,
  abstract     = {<p>Importance: Active surveillance is an important option to reduce prostate cancer overtreatment, but it remains underutilized in many countries. Models from the United States show that greater use of active surveillance is important for prostate cancer screening to be cost-effective.</p><p>Objectives: To perform an up-to-date, nationwide, population-based study on use of active surveillance for localized prostate cancer in Sweden.</p><p>Design, Setting, and Participants: Cross-sectional study in the National Prostate Cancer Register (NPCR) of Sweden from 2009 through 2014. The NPCR has data on 98% of prostate cancers diagnosed in Sweden and has comprehensive linkages to other nationwide databases. Overall, 32 518 men with a median age of 67 years were diagnosed with favorable-risk prostate cancer, including 4693, 15 403, and 17 115 men with very-low-risk (subset of the low-risk group) (clinical stage, T1c; Gleason score, ≤6; prostate-specific antigen [PSA], &lt;10 ng/mL; PSA density &lt;0.15 ng/mL/cm3; and &lt;8-mm total cancer length in ≤4 positive biopsy cores), low-risk (including all men in the very-low-risk group) (T1-T2; Gleason score, ≤6; and PSA, &lt;10 ng/mL), and intermediate-risk disease (T1-T2 with Gleason score, 7 and/or PSA, 10-20 ng/mL).</p><p>Exposures: Diagnosis with favorable-risk prostate cancer.</p><p>Main Outcomes and Measures: Utilization of active surveillance.</p><p>Results: The use of active surveillance increased in men of all ages from 57% (380 of 665) to 91% (939 of 1027) for very-low-risk prostate cancer and from 40% (1159 of 2895) to 74% (1951 of 2644) for low-risk prostate cancer, with the strongest increase occurring from 2011 onward. Among men aged 50 to 59 years, 88% (211 of 240) with very-low-risk and 68% (351 of 518) with low-risk disease chose active surveillance in 2014. Use of active surveillance for intermediate-risk disease remained lower, 19% (561 of 3030) in 2014.</p><p>Conclusions and Relevance: Active surveillance has become the dominant management for low-risk prostate cancer among men in Sweden, with the highest rates yet reported and almost complete uptake for very-low-risk cancer. These data should serve as a benchmark to compare the use of active surveillance for favorable-risk disease around the world.</p>},
  author       = {Loeb, Stacy and Folkvaljon, Yasin and Curnyn, Caitlin and Robinson, David and Bratt, Ola and Stattin, Pär},
  issn         = {2374-2437},
  language     = {eng},
  month        = {10},
  number       = {10},
  pages        = {1393--1398},
  publisher    = {American Medical Association},
  series       = {JAMA oncology},
  title        = {Uptake of Active Surveillance for Very-Low-Risk Prostate Cancer in Sweden},
  url          = {http://dx.doi.org/10.1001/jamaoncol.2016.3600},
  volume       = {3},
  year         = {2017},
}