Page 117 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Key Question 3. What factors affect the offer of, acceptance of, and
adherence to active surveillance?
For this Key Question, eligible studies included: (1) multivariable database analyses of
predictors for the offer of, acceptance of, and adherence to AS (or WW), (2) survey or interview
type studies addressing the same issues, and (3) experimental studies that examined a factor of
interest addressing the same issues, when applicable (e.g., the effect of decision aids on the
acceptance of AS). Eligible studies reporting multivariable analyses had to adjust for age and
disease stage or risk. We excluded studies in which AS/WW was not analyzed separately from
nonaggressive treatments like ADT. Similarly, for survey or interview type studies, only those
including men with prostate cancer and reporting data directly relevant to AS/WW were
reviewed. Of note, the outcomes of many of the studies were either treatment with an
observational strategy or interruption (cessation) of the observational strategy. Studies generally
did not directly analyze the offer of, acceptance of, and adherence to AS.
Figure 7 summarizes the studies reviewed for Key Question 3. Twenty-five studies reported
multivariable analyses of the association between different physician or patient factors, delivery
system, and the offer of, acceptance of, and adherence to, AS or WW. 66,77,159-181 These analyses
were mainly conducted on the CaPSURE or SEER databases. In addition, 16 survey or interview
type studies explored similar associations. 122,182-196 No experimental study specifically examined
factor(s) addressing the offer of, acceptance of, and adherence to AS. However, one relevant
systematic review detailed the use of decision-making tools and aids in the management of men
with prostate cancer. 197 As described in the Methods chapter, the included studies were those
initially identified in our search for publications concerning active surveillance, and from
references in relevant reviews. We did not do a targeted search for the specific factors of interest.
It should be noted that among this group of studies, only two specifically targeted men who
were put on an active monitoring protocol with triggers for curative treatments. 172,173 The
remainders were analyses of men who were either not treated or not initially treated. We could
not determine whether they were on an active monitoring protocol with triggers for curative
treatments.

63