Reasons for Discontinuing Active Surveillance

Assessment of 21 Centres in 12 Countries in the Movember GAP3 Consortium

Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium, Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium

Research output: Contribution to journalArticle

Abstract

Background: Careful assessment of the reasons for discontinuation of active surveillance (AS) is required for men with prostate cancer (PCa). Objective: Using Movember's Global Action Plan Prostate Cancer Active Surveillance initiative (GAP3) database, we report on reasons for AS discontinuation. Design, setting, and participants: We compared data from 10 296 men on AS from 21 centres across 12 countries. Outcome measurements and statistical analysis: Cumulative incidence methods were used to estimate the cumulative incidence rates of AS discontinuation. Results and limitations: During 5-yr follow-up, 27.5% (95% confidence interval [CI]: 26.4–28.6%) men showed signs of disease progression, 12.8% (95% CI: 12.0–13.6%) converted to active treatment without evidence of progression, 1.7% (95% CI: 1.5–2.0%) continued to watchful waiting, and 1.7% (95% CI: 1.4–2.1%) died from other causes. Of the 7049 men who remained on AS, 2339 had follow-up for >5 yr, 4561 had follow-up for <5 yr, and 149 were lost to follow-up. Cumulative incidence of progression was 27.5% (95% CI: 26.4–28.6%) at 5 yr and 38.2% (95% CI: 36.7–39.9%) at 10 yr. A limitation is that not all centres were included due to limited information on the reason for discontinuation and limited follow-up. Conclusions: Our descriptive analyses of current AS practices worldwide showed that 43.6% of men drop out of AS during 5-yr follow-up, mainly due to signs of disease progression. Improvements in selection tools for AS are thus needed to correctly allocate men with PCa to AS, which will also reduce discontinuation due to conversion to active treatment without evidence of disease progression. Patient summary: Our assessment of a worldwide database of men with prostate cancer (PCa) on active surveillance (AS) shows that 43.6% drop out of AS within 5 yr, mainly due to signs of disease progression. Better tools are needed to select and monitor men with PCa as part of AS.

Original languageEnglish (US)
Pages (from-to)523-531
Number of pages9
JournalEuropean Urology
Volume75
Issue number3
DOIs
StatePublished - Mar 1 2019

Fingerprint

Factual Databases
Watchful Waiting
Predictive Value of Tests
Kallikreins
Patient Dropouts
Prostate-Specific Antigen
North America
Early Detection of Cancer
Disease Progression
Cause of Death
Prostatic Neoplasms
Biopsy
Confidence Intervals
Incidence
Databases
Clinical Decision-Making
Lost to Follow-Up

Keywords

  • Active surveillance
  • Discontinuation
  • Prostate cancer
  • Worldwide

ASJC Scopus subject areas

  • Urology

Cite this

Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium, & Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium (2019). Reasons for Discontinuing Active Surveillance: Assessment of 21 Centres in 12 Countries in the Movember GAP3 Consortium. European Urology, 75(3), 523-531. https://doi.org/10.1016/j.eururo.2018.10.025

Reasons for Discontinuing Active Surveillance : Assessment of 21 Centres in 12 Countries in the Movember GAP3 Consortium. / Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium; Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium.

In: European Urology, Vol. 75, No. 3, 01.03.2019, p. 523-531.

Research output: Contribution to journalArticle

Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium & Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium 2019, 'Reasons for Discontinuing Active Surveillance: Assessment of 21 Centres in 12 Countries in the Movember GAP3 Consortium', European Urology, vol. 75, no. 3, pp. 523-531. https://doi.org/10.1016/j.eururo.2018.10.025
Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium, Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium. Reasons for Discontinuing Active Surveillance: Assessment of 21 Centres in 12 Countries in the Movember GAP3 Consortium. European Urology. 2019 Mar 1;75(3):523-531. https://doi.org/10.1016/j.eururo.2018.10.025
Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium ; Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium. / Reasons for Discontinuing Active Surveillance : Assessment of 21 Centres in 12 Countries in the Movember GAP3 Consortium. In: European Urology. 2019 ; Vol. 75, No. 3. pp. 523-531.
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abstract = "Background: Careful assessment of the reasons for discontinuation of active surveillance (AS) is required for men with prostate cancer (PCa). Objective: Using Movember's Global Action Plan Prostate Cancer Active Surveillance initiative (GAP3) database, we report on reasons for AS discontinuation. Design, setting, and participants: We compared data from 10 296 men on AS from 21 centres across 12 countries. Outcome measurements and statistical analysis: Cumulative incidence methods were used to estimate the cumulative incidence rates of AS discontinuation. Results and limitations: During 5-yr follow-up, 27.5{\%} (95{\%} confidence interval [CI]: 26.4–28.6{\%}) men showed signs of disease progression, 12.8{\%} (95{\%} CI: 12.0–13.6{\%}) converted to active treatment without evidence of progression, 1.7{\%} (95{\%} CI: 1.5–2.0{\%}) continued to watchful waiting, and 1.7{\%} (95{\%} CI: 1.4–2.1{\%}) died from other causes. Of the 7049 men who remained on AS, 2339 had follow-up for >5 yr, 4561 had follow-up for <5 yr, and 149 were lost to follow-up. Cumulative incidence of progression was 27.5{\%} (95{\%} CI: 26.4–28.6{\%}) at 5 yr and 38.2{\%} (95{\%} CI: 36.7–39.9{\%}) at 10 yr. A limitation is that not all centres were included due to limited information on the reason for discontinuation and limited follow-up. Conclusions: Our descriptive analyses of current AS practices worldwide showed that 43.6{\%} of men drop out of AS during 5-yr follow-up, mainly due to signs of disease progression. Improvements in selection tools for AS are thus needed to correctly allocate men with PCa to AS, which will also reduce discontinuation due to conversion to active treatment without evidence of disease progression. Patient summary: Our assessment of a worldwide database of men with prostate cancer (PCa) on active surveillance (AS) shows that 43.6{\%} drop out of AS within 5 yr, mainly due to signs of disease progression. Better tools are needed to select and monitor men with PCa as part of AS.",
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T1 - Reasons for Discontinuing Active Surveillance

T2 - Assessment of 21 Centres in 12 Countries in the Movember GAP3 Consortium

AU - Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium

AU - Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium

AU - Van Hemelrijck, Mieke

AU - Ji, Xi

AU - Kattan, Mike W.

AU - Helleman, Jozien

AU - Roobol, Monique J.

AU - Nieboer, Daan

AU - Bangma, Chris H.

AU - van der Linden, Wim

AU - Frydenberg, Mark

AU - Frydenberg, Mark

AU - Rannikko, Antti

AU - Lee, Lui S.

AU - Gnanapragasam, Vincent J.

AU - Trock, Bruce

AU - Ehdaie, Behfar

AU - Carroll, Peter

AU - Filson, Christopher

AU - Kim, Jeri

AU - Logothetis, Christopher

AU - Morgan, Todd

AU - Klotz, Laurence

AU - Pickles, Tom

AU - Hyndman, Eric

AU - Moore, Caroline M.

AU - Gnanapragasam, Vincent

AU - Van Hemelrijck, Mieke

AU - Dasgupta, Prokar

AU - Bangma, Chris

AU - Roobol, Monique

AU - Villers, Arnauld

AU - Rannikko, Antti

AU - Valdagni, Riccardo

AU - Perry, Antoinette

AU - Hugosson, Jonas

AU - Rubio-Briones, Jose

AU - Bjartell, Anders

AU - Hefermehl, Lukas

AU - Lui Shiong, Lee

AU - Frydenberg, Mark

AU - Kakehi, Yoshiyuki

AU - Ha Chung, Byung

AU - van der Kwast, Theo

AU - Obbink, Henk

AU - van der Linden, Wim

AU - Hulsen, Tim

AU - de Jonge, Cees

AU - Kattan, Mike

AU - Xinge, Ji

AU - Muir, Kenneth

AU - Lophatananon, Artitaya

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background: Careful assessment of the reasons for discontinuation of active surveillance (AS) is required for men with prostate cancer (PCa). Objective: Using Movember's Global Action Plan Prostate Cancer Active Surveillance initiative (GAP3) database, we report on reasons for AS discontinuation. Design, setting, and participants: We compared data from 10 296 men on AS from 21 centres across 12 countries. Outcome measurements and statistical analysis: Cumulative incidence methods were used to estimate the cumulative incidence rates of AS discontinuation. Results and limitations: During 5-yr follow-up, 27.5% (95% confidence interval [CI]: 26.4–28.6%) men showed signs of disease progression, 12.8% (95% CI: 12.0–13.6%) converted to active treatment without evidence of progression, 1.7% (95% CI: 1.5–2.0%) continued to watchful waiting, and 1.7% (95% CI: 1.4–2.1%) died from other causes. Of the 7049 men who remained on AS, 2339 had follow-up for >5 yr, 4561 had follow-up for <5 yr, and 149 were lost to follow-up. Cumulative incidence of progression was 27.5% (95% CI: 26.4–28.6%) at 5 yr and 38.2% (95% CI: 36.7–39.9%) at 10 yr. A limitation is that not all centres were included due to limited information on the reason for discontinuation and limited follow-up. Conclusions: Our descriptive analyses of current AS practices worldwide showed that 43.6% of men drop out of AS during 5-yr follow-up, mainly due to signs of disease progression. Improvements in selection tools for AS are thus needed to correctly allocate men with PCa to AS, which will also reduce discontinuation due to conversion to active treatment without evidence of disease progression. Patient summary: Our assessment of a worldwide database of men with prostate cancer (PCa) on active surveillance (AS) shows that 43.6% drop out of AS within 5 yr, mainly due to signs of disease progression. Better tools are needed to select and monitor men with PCa as part of AS.

AB - Background: Careful assessment of the reasons for discontinuation of active surveillance (AS) is required for men with prostate cancer (PCa). Objective: Using Movember's Global Action Plan Prostate Cancer Active Surveillance initiative (GAP3) database, we report on reasons for AS discontinuation. Design, setting, and participants: We compared data from 10 296 men on AS from 21 centres across 12 countries. Outcome measurements and statistical analysis: Cumulative incidence methods were used to estimate the cumulative incidence rates of AS discontinuation. Results and limitations: During 5-yr follow-up, 27.5% (95% confidence interval [CI]: 26.4–28.6%) men showed signs of disease progression, 12.8% (95% CI: 12.0–13.6%) converted to active treatment without evidence of progression, 1.7% (95% CI: 1.5–2.0%) continued to watchful waiting, and 1.7% (95% CI: 1.4–2.1%) died from other causes. Of the 7049 men who remained on AS, 2339 had follow-up for >5 yr, 4561 had follow-up for <5 yr, and 149 were lost to follow-up. Cumulative incidence of progression was 27.5% (95% CI: 26.4–28.6%) at 5 yr and 38.2% (95% CI: 36.7–39.9%) at 10 yr. A limitation is that not all centres were included due to limited information on the reason for discontinuation and limited follow-up. Conclusions: Our descriptive analyses of current AS practices worldwide showed that 43.6% of men drop out of AS during 5-yr follow-up, mainly due to signs of disease progression. Improvements in selection tools for AS are thus needed to correctly allocate men with PCa to AS, which will also reduce discontinuation due to conversion to active treatment without evidence of disease progression. Patient summary: Our assessment of a worldwide database of men with prostate cancer (PCa) on active surveillance (AS) shows that 43.6% drop out of AS within 5 yr, mainly due to signs of disease progression. Better tools are needed to select and monitor men with PCa as part of AS.

KW - Active surveillance

KW - Discontinuation

KW - Prostate cancer

KW - Worldwide

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