Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 153 No. 7 (2023)

Retrospective analysis of the uptake of active surveillance for low-risk prostate cancer in Zurich, Switzerland

DOI
https://doi.org/10.57187/smw.2023.40103
Cite this as:
Swiss Med Wkly. 2023;153:40103
Published
27.07.2023

Summary

OBJECTIVES: Active surveillance for low-risk prostate cancer closely monitors patients conservatively instead of the pursuit of active treatment to reduce overtreatment of insignificant disease. Since 2009, active surveillance has been recommended as the primary management option in the European Association of Urology guidelines for low-risk disease. The present study aimed to investigate the use and uptake of active surveillance over 10 years in our certified prostate cancer centre (University Hospital of Zurich) compared with those derived from the cancer registry of the canton of Zurich, Switzerland.

MATERIALS AND METHODS: We retrospectively identified all men diagnosed with low-risk prostate cancer at our institution and from the cancer registry of the canton of Zurich from 2009 to 2018. The primary treatment of each patient was recorded. Descriptive statistics were used to analyze the use of different treatments in our centre. The results were compared with those derived from the cancer registry.

RESULTS: A total of 3393 men with low-risk prostate cancer were included in this study (University Hospital of Zurich: n = 262; cancer registry: n = 3131). In the University Hospital of Zurich and cancer registry cohorts, 146 (55.7%) and 502 (16%) men underwent active surveillance, respectively. The proportions of local treatment [115 (43.9%) vs 2220 (71%)] and androgen deprivation therapy [0 (0%) vs 43 (1.4%)] were distinctly lower in the University Hospital of Zurich cohort than in the cancer registry cohort. The uptake of active surveillance over the years was high in the University Hospital of Zurich cohort (35.4% in 2009 and 88.2% in 2018) but only marginal in the cancer registry cohort (12.2% in 2009 and 16.2% in 2018).

CONCLUSION: Despite clear guideline recommendations, active surveillance for low-risk prostate cancer is still widely underused. Our analysis showed that access to a certified interdisciplinary tumour board significantly increases the use of active surveillance.

References

  1. Mottet N, van den Bergh RC, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer—2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2020:1–20. 10.1016/j.eururo.2020.09.042 DOI: https://doi.org/10.1016/j.eururo.2020.09.042
  2. Schaeffer E, Srinivas S, Antonarakis ES, Armstrong AJ, Bekelman JE, Cheng H, et al. Prostate cancer, version 1.2021: featured updates to the nccn guidelines. JNCCN Journal of the National Comprehensive Cancer Network. 2021;19:134–43. 10.6004/jnccn.2021.0008 DOI: https://doi.org/10.6004/jnccn.2021.0008
  3. Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, et al. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part II: Recommended Approaches and Details of Specific Care Options. J Urol. 2018 Apr;199(4):990–7. 10.1016/j.juro.2018.01.002 DOI: https://doi.org/10.1016/j.juro.2018.01.002
  4. Al Hussein Al Awamlh B, Patel N, Ma X, Calaway A, Ponsky L, Hu JC, et al. Variation in the Use of Active Surveillance for Low-Risk Prostate Cancer Across US Census Regions. Front Oncol. 2021 May;11:644885. 10.3389/fonc.2021.644885 DOI: https://doi.org/10.3389/fonc.2021.644885
  5. Washington SL 3rd, Jeong CW, Lonergan PE, Herlemann A, Gomez SL, Carroll PR, et al. Regional Variation in Active Surveillance for Low-Risk Prostate Cancer in the US. JAMA Netw Open. 2020 Dec;3(12):e2031349. 10.1001/jamanetworkopen.2020.31349 DOI: https://doi.org/10.1001/jamanetworkopen.2020.31349
  6. Löppenberg B, Friedlander DF, Krasnova A, Tam A, Leow JJ, Nguyen PL, et al. Variation in the use of active surveillance for low-risk prostate cancer. Cancer. 2018 Jan;124(1):55–64. 10.1002/cncr.30983 DOI: https://doi.org/10.1002/cncr.30983
  7. Loeb S, Folkvaljon Y, Curnyn C, Robinson D, Bratt O, Stattin P. Uptake of active surveillance for very-low-risk prostate cancer in Sweden. JAMA Oncol. 2017 Oct;3(10):1393–8. 10.1001/jamaoncol.2016.3600 DOI: https://doi.org/10.1001/jamaoncol.2016.3600
  8. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA; Grading Committee. The 2014 international society of urological pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma definition of grading patterns and proposal for a new grading system. Am J Surg Pathol. 2016 Feb;40(2):244–52. 10.1097/PAS.0000000000000530 DOI: https://doi.org/10.1097/PAS.0000000000000530
  9. Klotz L, Vesprini D, Sethukavalan P, Jethava V, Zhang L, Jain S, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol. 2015 Jan;33(3):272–7. 10.1200/JCO.2014.55.1192 DOI: https://doi.org/10.1200/JCO.2014.55.1192
  10. Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP, et al.; European Association of Urology. [EAU guidelines on prostate cancer]. Actas Urol Esp. 2009 Feb;33(2):113–26. 10.1016/s0210-4806(09)74110-5 10.1016/S0210-4806(09)74110-5 DOI: https://doi.org/10.1016/S0210-4806(09)74110-5
  11. Werntz RP, Eggener SE. Re: Use of Active Surveillance or Watchful Waiting for Low-risk Prostate Cancer and Management Trends Across Risk Groups in the United States 2010-2015. Eur Urol. 2019 Aug;76(2):252. 10.1016/j.eururo.2019.03.041 DOI: https://doi.org/10.1016/j.eururo.2019.03.041
  12. Iskandar H, Yan Y, Elwing J, Early D, Colditz GA, Wang JS. Predictors of Poor Adherence of US Gastroenterologists with Colonoscopy Screening and Surveillance Guidelines. Dig Dis Sci. 2015 Apr;60(4):971–8. 10.1007/s10620-014-3403-0 DOI: https://doi.org/10.1007/s10620-014-3403-0
  13. Cacciamani G, Artibani W, Briganti A, N’Dow J. Adherence to the European Association of Urology Guidelines: A National Survey among Italian Urologists. Urol Int. 2018;100(2):139–45. 10.1159/000486344 DOI: https://doi.org/10.1159/000486344
  14. Zhang Z, Modi PK, Shahinian V, Herrel LA, Dupree JM, Yan P, et al. Active Surveillance vs Immediate Treatment-Which Has a Greater Financial Incentive for Urologists? Urol Pract. 2020 May;7(3):182–7. 10.1097/upj.0000000000000081 10.1097/UPJ.0000000000000081 DOI: https://doi.org/10.1097/UPJ.0000000000000081
  15. Butler SS, Loeb S, Cole AP, Zaslowe-Dude C, Muralidhar V, Kim DW, et al. United States trends in active surveillance or watchful waiting across patient socioeconomic status from 2010 to 2015. Prostate Cancer Prostatic Dis. 2020 Mar;23(1):179–83. 10.1038/s41391-019-0175-9 DOI: https://doi.org/10.1038/s41391-019-0175-9
  16. Timilshina N, Ouellet V, Alibhai SM, Mes-Masson AM, Delvoye N, Drachenberg D, et al. Analysis of active surveillance uptake for low-risk localized prostate cancer in Canada: a Canadian multi-institutional study. World J Urol. 2017 Apr;35(4):595–603. 10.1007/s00345-016-1897-0 DOI: https://doi.org/10.1007/s00345-016-1897-0
  17. Ong WL, Evans SM, Evans M, Tacey M, Dodds L, Kearns P, et al. Trends in Conservative Management for Low-risk Prostate Cancer in a Population-based Cohort of Australian Men Diagnosed Between 2009 and 2016. Eur Urol Oncol. 2021 Apr;4(2):319–22. 10.1016/j.euo.2019.04.006 DOI: https://doi.org/10.1016/j.euo.2019.04.006
  18. Aizer AA, Paly JJ, Zietman AL, Nguyen PL, Beard CJ, Rao SK, et al. Models of care and NCCN guideline adherence in very-low-risk prostate cancer. J Natl Compr Canc Netw. 2013 Nov;11(11):1364–72. 10.6004/jnccn.2013.0160 DOI: https://doi.org/10.6004/jnccn.2013.0160
  19. Kowalski C, Graeven U, von Kalle C, Lang H, Beckmann MW, Blohmer JU, et al. Shifting cancer care towards Multidisciplinarity: the cancer center certification program of the German cancer society. BMC Cancer. 2017 Dec;17(1):850. 10.1186/s12885-017-3824-1 DOI: https://doi.org/10.1186/s12885-017-3824-1
  20. Butea-Bocu MC, Müller G, Pucheril D, Kröger E, Otto U. Is there a clinical benefit from prostate cancer center certification? An evaluation of functional and oncologic outcomes from 22,649 radical prostatectomy patients. World J Urol. 2021 Jan;39(1):5–10. 10.1007/s00345-020-03411-9 DOI: https://doi.org/10.1007/s00345-020-03411-9
  21. Kobayashi H, Yamamoto H, Miyata H, Gotoh M, Kotake K, Sugihara K, et al. Impact of adherence to board-certified surgeon systems and clinical practice guidelines on colon cancer surgical outcomes in Japan: A questionnaire survey of the National Clinical Database. Ann Gastroenterol Surg. 2020 Apr;4(3):283–93. 10.1002/ags3.12327 DOI: https://doi.org/10.1002/ags3.12327
  22. Kreienberg R, Wöckel A, Wischnewsky M. Highly significant improvement in guideline adherence, relapse-free and overall survival in breast cancer patients when treated at certified breast cancer centres: an evaluation of 8323 patients. Breast. 2018 Aug;40:54–9. 10.1016/j.breast.2018.04.002 DOI: https://doi.org/10.1016/j.breast.2018.04.002
  23. Harding C, Pompei F, Burmistrov D, Wilson R. Use of mastectomy for overdiagnosed breast cancer in the United States: analysis of the seer 9 cancer registries. J Cancer Epidemiol. 2019 Jan;2019:5072506. 10.1155/2019/5072506 DOI: https://doi.org/10.1155/2019/5072506

Most read articles by the same author(s)