Drivers for treatment in an active surveillance cohort.

Abstract

66 Background: Active Surveillance (AS) for Prostate Cancer (CaP) has become an established management option for patients (pts) with low-risk CaP. We examined the drivers of selecting treatment (tx) over time from a cohort of AS pts seen in a radiation oncology department. Methods: Pts seen in consultation with low-risk CaP were offered AS as one management option. A review of 2,545 pt charts with newly diagnosed CaP from 2010-2016 was undertaken with 794 (31.2%) meeting criteria for AS and ultimately 166 (20.6%) of those patients choosing AS within our department. 22 patients opted to discontinue surveillance before their confirmatory studies. Results: 145 pts elected AS and 66 (45.5%) ultimately required or chose tx. 138 (81.3%) of patients had Gleason 3+3, 28 (17%) had Gleason 3+4 and 3 (1.8%) had Gleason 4+3. The majority (96.4%) were T1c and 112 (67%) were characterized as having NCCN very low risk with a mean PSA of 5.38ng/mL (± 2.38ng/mL). Of the 66 pts who underwent tx, 36 (54.7%) were due to an increase in Gleason score or PSA rise, 14 (21%) electively decided against further AS, 6 (9%) for radiographic progression and 10 (15%) for other. Tx choices are presented in Table 1 with 54 pts (81%) choosing a radiotherapeutic (RT) intervention. The median time to initiate tx was 3.8 years from diagnosis. Conclusions: Men with low-risk CaP and eligible for AS elected AS 21% of the time with slightly less than half of the AS cohort converting to tx within 4 years. The main drivers for tx was either an increase in Gleason score or rise in PSA, followed by patient anxiety regarding diagnosis. Trends over time identified an increase in men electing AS but additional efforts are underway to educate pts on informed decision making and addressing diagnosis anxiety to maintain AS status. A significant proportion of patients chose a RT intervention, perhaps reflecting tx bias towards the physician performing the surveillance. [Table: see text]