Treatment in the absence of disease reclassification among men on active surveillance for prostate cancer

• Authors: Peter S Kirk, University of Washington; Kehao Zhu, Fred Hutchinson Cancer Research Center; Yingye Zheng, Fred Hutchinson Cancer Research Center; Lisa F Newcomb, University of Washington; Jeannette M Schenk, Fred Hutchinson Cancer Research Center; James D Brooks, Stanford University; Peter R Carroll, University of California San Francisco; Atreya Dash, VA Puget Sound Health Care Systems; William J Ellis, University of Washington; Christopher Filson, Emory University; Martin E Gleave, University of British Columbia; Michael Liss, University of Texas Health Sciences Center; Frances Martin, Eastern Virginia Medical School; Jesse K McKenney, Cleveland Clinic; Todd M Morgan, University of Michigan; Peter S Nelson, Fred Hutchinson Cancer Research Center; Ian M Thompson, CHRISTUS Medical Center Hospital; Andrew A Wagner, Beth Israel Deaconess Medical Center; Daniel W Lin, University of Washington; John L Gore, University of Washington
• Journal Title: CANCER
• Volume: Volume 128, Number 2
• Publisher: WILEY | 2021-09-13, Pages 269-274
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1002/cncr.33911
• Subjects: Health Sciences, Pathology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; active surveillance; prostatic neoplasms; quality of life; FOLLOW-UP; COHORT; PRIAS

Abstract

Background: Maintaining men on active surveillance for prostate cancer can be challenging. Although most men who eventually undergo treatment have experienced clinical progression, a smaller subset elects treatment in the absence of disease reclassification. This study sought to understand factors associated with treatment in a large, contemporary, prospective cohort. Methods: This study identified 1789 men in the Canary Prostate Cancer Active Surveillance Study cohort enrolled as of 2020 with a median follow-up of 5.6 years. Clinical and demographic data as well as information on patient-reported quality of life and urinary symptoms were used in multivariable Cox proportional hazards regression models to identify factors associated with the time to treatment. Results: Within 4 years of their diagnosis, 33% of men (95% confidence interval [CI], 30%-35%) underwent treatment, and 10% (95% CI, 9%-12%) were treated in the absence of reclassification. The most significant factor associated with any treatment was an increasing Gleason grade group (adjusted hazard ratio [aHR], 14.5; 95% CI, 11.7-17.9). Urinary quality-of-life scores were associated with treatment without reclassification (aHR comparing “mostly dissatisfied/terrible” with “pleased/mixed,” 2.65; 95% CI, 1.54-4.59). In a subset analysis (n = 692), married men, compared with single men, were more likely to undergo treatment in the absence of reclassification (aHR, 2.63; 95% CI, 1.04-6.66). Conclusions: A substantial number of men with prostate cancer undergo treatment in the absence of clinical changes in their cancers, and quality-of-life changes and marital status may be important factors in these decisions. Lay Summary: This analysis of men on active surveillance for prostate cancer shows that approximately 1 in 10 men will decide to be treated within 4 years of their diagnosis even if their cancer is stable. These choices may be related in part to quality-or-life or spousal concerns.