In Prostate Cancer and Prostatic Diseases Katja Aben and colleagues showed that most Dutch patients with very low risk prostate cancer are managed with active surveillance, thereby delaying and possible avoiding therapy and its side effects. Variation in the proportion of patients with active surveillance in individual hospitals exists but is limited. These results are based on the nationwide initiative ProZIB (ProstaatkankerZorg In Beeld).Background
To provide insight in the treatment variation of very-low-risk prostate cancer patients and to assess the role of hospital-related factors.
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.
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.
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.
Immediate treatment vs. active-surveillance in very-low-risk prostate cancer: the role of patient-, tumour-, and hospital-related factors.
Jansen H, van Oort IM, van Andel G, Wijsman BP, Pos FJ, Hulshof MCCM, Hulsbergen-van de Kaa CA, van Leenders GJLH, Fütterer JJ, Somford DM, Busstra MB, van Moorselaar RJA, Kiemeney LA, Aben KKH.
Katja Aben is member of theme Urological cancers.
Related news items
Research Integrity Round 16 September 2020 Sex and gender and research integrity: a tale of how and who9 July 2020
Topic of this webinar is sex and gender in (bio)medical research. Speakers are dean Prof. Jan Smit, Prof. Sabine Oertelt–Prigione and Prof. Hanneke Takkenberg (ErasmusMC). All junior and senior researchers are invited to join the discussion. Please register via the website.read more
Finally, an explanation for hearing loss in twelve Dutch families9 July 2020
The culprit is a genetic abnormality, a discovery that immediately makes it one of the most common causes of hereditary hearing loss in the Netherlands.read more
Rebecca Halbach receives idea generator grant to fight mosquito transmitted viruses8 July 2020
Rebecca Halbach and Pascal Miesen have investigated in a collaborative project whether the treatment of mosquitoes with antiviral drugs can prevent the transmission of mosquito-transmitted viral diseases.read more
Invasive fungal infections in influenza and COVID-198 July 2020
The Aspergillus fungus is found in the lungs of many COVID patients. A parallel occurs with influenza patients, who often develop a serious fungal infection. Although such a serious fungal infection seems to occur less frequently in COVID-patients, alertness remains necessary,read more
Werner Koopman 25 years at Radboudumc celebrating online8 July 2020
Werner Koopman completed his 25 years at Radboudumc. Biochemistry sent him a cake at home and celebrated this special moment during COVID-19 in a unique way.read more