Department of Uro-Oncology, The Royal Marsden Hospital, London, UK; Translational Oncology and Urology Research, King's College London, London, UK; Centre for Population Health Research, University of South Australia, Adelaide, Australia.
Translational Oncology and Urology Research, King's College London, London, UK; Centre for Population Health Research, University of South Australia, Adelaide, Australia; Department of Urology, Guys and St. Thomas NHS Foundation Trust, London, UK.
Eur Urol Oncol. 2019 Jul;2(4):464-470. doi: 10.1016/j.euo.2018.09.007. Epub 2018 Oct 11.
Researchers remain divided on the major causes of dropout from active surveillance (AS), with rates of up to 38% among men with no evidence of prostate cancer (PC) progression.
To develop and evaluate an educational intervention in terms of adherence to AS among men with low- to intermediate-risk PC.
DESIGN, SETTING, AND PARTICIPANTS: We first carried out focus group discussions with men who had remained on and dropped out of AS to inform an intervention to increase adherence to AS. A total of 255 consecutive men who had selected AS were then recruited to either standard care (written information and access to a nurse specialist) or standard care and the intervention.
An educational seminar was designed by patients and clinicians including information on imaging, biopsy techniques, understanding pathology, large AS cohorts - mortality and morbidity risk and diet and lifestyle advice.
The proportion of men dropping out of AS for reasons other than disease progression was assessed at 1 and 5yr after AS selection using multivariate logistic regression.
Common themes influencing decision-making by men on AS were identified: (1) clinical consistency; (2) information; and (3) lifestyle advice. Addition of an educational seminar led to significantly fewer men dropping out of AS: at 1 and 5yr the dropout rate was 25% and 42%, respectively, in the standard care group, compared to 11% and 22% (p=0.001) in the intervention group. In the intervention group, 18 men failed to attend the seminar.
The AS dropout rate was halved following a single educational seminar delivered to groups of men with intermediate- or low-risk PC, even at 5yr.
Men on active surveillance (AS) for prostate cancer feel more supported when provided with an educational seminar within 3 mo of their treatment choice. The seminar halved the number of men dropping-out of AS, even at 5yr.
研究人员对于主动监测（AS）中脱落的主要原因仍存在分歧，在没有前列腺癌（PC）进展证据的男性中，其比例高达 38%。
针对中低危 PC 男性，开发并评估一种关于 AS 依从性的教育干预措施。
设计、地点和参与者：我们首先对仍在接受 AS 治疗和已经脱落的男性进行了焦点小组讨论，以获得有关提高 AS 依从性的干预措施的信息。随后，共招募了 255 名连续选择 AS 的男性，他们被随机分配到标准护理（书面信息和护士专家咨询）或标准护理加干预组。
由患者和临床医生设计了一个教育研讨会，内容包括影像学、活检技术、病理学知识、大规模 AS 队列-死亡率和发病率风险以及饮食和生活方式建议。
使用多变量逻辑回归，在 AS 选择后 1 年和 5 年，评估了因疾病进展以外的原因退出 AS 的男性比例。结果：在标准护理组中，1 年和 5 年时的退出率分别为 25%和 42%，而在干预组中分别为 11%和 22%（p=0.001）。在干预组中，有 18 名男性未能参加研讨会。
在向中低危 PC 男性提供单次教育研讨会后，AS 的退出率降低了一半，即使在 5 年时也是如此。
接受中低危 PC 治疗的男性在治疗选择后 3 个月内接受教育研讨会，会感到更受支持。该研讨会将 AS 退出人数减少了一半，即使在 5 年时也是如此。
