Ahlberg Mats S, Garmo Hans, Holmberg Lars, Bill-Axelson Anna
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Regional Cancer Center Uppsala/Örebro, Uppsala University Hospital, Uppsala, Sweden.
Eur Urol Open Sci. 2023 May 15;52:166-173. doi: 10.1016/j.euros.2023.04.006. eCollection 2023 Jun.
Regional differences in active surveillance (AS) uptake for prostate cancer (PC) illustrate an inequality in treatment strategies.
To examine the association between regional differences in AS uptake and transition to radical treatment, start of androgen deprivation therapy (ADT), watchful waiting, or death.
A Swedish population-based cohort study was conducted including men in the National Prostate Cancer Register in Sweden with low-risk or favorable intermediate-risk PC, starting AS from January 1, 2007 and continuing till December 31, 2019.
Regional tradition of low, intermediate, or high proportions of immediate radical treatment.
Probabilities of transition from AS to radical treatment, start of ADT, watchful waiting, or death from other causes were assessed.
We included 13 679 men. The median age was 66 yr, median PSA 5.1 ng/ml, and median follow-up 5.7 yr. Men from regions with a high AS uptake had a lower probability of transition to radical treatment (36%) than men from regions with a low AS uptake (40%; absolute difference 4.1%; 95% confidence interval [CI] 1.0-7.2), but not a higher probability of AS failure defined as the start of ADT (absolute difference 0.4%; 95% CI -0.7 to 1.4). There were no statistically significant differences in the probability of transition to watchful waiting or death from other causes. Limitations include uncertainty in the estimation of remaining lifetime and transition to watchful waiting.
A regional tradition of a high AS uptake is associated with a lower probability of transition to radical treatment, but not with AS failure. A low AS uptake suggests overtreatment.
There are considerable regional differences in active surveillance (AS) uptake for prostate cancer. This study compared the outcomes of AS in different regions and found no association between AS uptake and failure of AS; it suggests that a low AS uptake indicates overtreatment.
前列腺癌（PC）主动监测（AS）的地区差异表明治疗策略存在不平等。
研究AS采用率的地区差异与向根治性治疗的转变、雄激素剥夺治疗（ADT）的开始、观察等待或死亡之间的关联。
设计、设置和参与者：开展了一项基于瑞典人群的队列研究，纳入瑞典国家前列腺癌登记处中患有低风险或有利的中风险PC且于2007年1月1日开始AS并持续至2019年12月31日的男性。
低、中或高比例即刻根治性治疗的地区传统。
评估了从AS转变为根治性治疗、开始ADT、观察等待或死于其他原因的概率。
我们纳入了13679名男性。中位年龄为66岁，中位前列腺特异性抗原（PSA）为5.1 ng/ml，中位随访时间为5.7年。与AS采用率低的地区的男性相比，AS采用率高的地区的男性向根治性治疗转变的概率较低（36%）（40%；绝对差异4.1%；95%置信区间[CI] 1.0 - 7.2），但定义为开始ADT的AS失败概率并不更高（绝对差异0.4%；95% CI -0.7至1.4）。向观察等待或死于其他原因的转变概率无统计学显著差异。局限性包括剩余寿命估计和向观察等待转变的不确定性。
高AS采用率的地区传统与向根治性治疗转变的概率较低相关，但与AS失败无关。低AS采用率提示过度治疗。
前列腺癌的主动监测采用率存在相当大的地区差异。本研究比较了不同地区AS的结果，发现AS采用率与AS失败之间无关联；这表明低AS采用率提示过度治疗。
