Factors associated with switching from active surveillance to treatment in men with low-risk prostate cancer: A population-based study.

Background: The authors sought to identify modifiable and nonmodifiable factors associated with switching from active surveillance to treatment among men with low-risk prostate cancer (LRPC).

Methods: Eligible men with low-risk prostate cancer (prostate-specific antigen <10 ng/mL, Gleason score ≤6, clinical stage ≤T2a) were identified from two population-based cancer registries (in Metropolitan Detroit and the State of Georgia). All participants received a baseline survey and men who adopted active surveillance (AS) were mailed a second survey at 2 years after diagnosis, rating factors regarding their decision to remain on AS or switch to treatment. A multivariable logistic regression model was used to assess factors associated with a transition from AS to treatment.

Results: The cohort consisted of 725 men who completed the follow-up survey, of whom, 578 (80%) were still on AS and 147 (20%) switched from AS to definitive treatment at 2 years. Survey responses such as "desire to get rid of cancer" (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.81-3.08, p < .001), and "worry about untreated cancer" (OR, 1.81; 95% CI, 1.38-2.38, p < .001) were associated with switching to treatment. Patients in Georgia were demographically similar to those in Detroit, but more likely to switch from AS to treatment (OR, 1.63; 95% CI, 1.00-2.64, p = .05).

Conclusions: The findings of this study highlight that patient education and understanding of active surveillance are important, both at diagnosis and throughout the management of AS. Differences between Detroit and Georgia suggest that unified education initiatives may play a role helping patients make informed decisions regarding prostate cancer management.