TY - JOUR
T1 - Immediate treatment vs. active-surveillance in very-low-risk prostate cancer: the role of patient-, tumour-, and hospital-related factors
AU - Jansen, Hanneke
AU - van Oort, Inge M.
AU - van Andel, George
AU - Wijsman, Bart P.
AU - Pos, Floris J.
AU - Hulshof, Maarten C. C. M.
AU - Hulsbergen-van de Kaa, Christina A.
AU - van Leenders, Geert J. L. H.
AU - Fütterer, Jurgen.J.
AU - Somford, Diederink M.
AU - Busstra, Martijn B.
AU - van Moorselaar, Reindert J. A.
AU - Kiemeney, Lambertus A.
AU - Aben, Katja K. H.
PY - 2019
Y1 - 2019
N2 - 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.
AB - 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85056631729&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30429595
U2 - 10.1038/s41391-018-0109-y
DO - 10.1038/s41391-018-0109-y
M3 - Article
C2 - 30429595
VL - 22
SP - 337
EP - 343
JO - Prostate Cancer and Prostatic Diseases
JF - Prostate Cancer and Prostatic Diseases
SN - 1365-7852
IS - 4
ER -