Page 121 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Adherence to AS. No study or survey specifically addressed how the involvement of a
consulting physician might affect adherence to AS.

Clinical Factors
Offer of AS. One survey of 1063 urologists and radiation oncologists reported that about 10 to
20 percent would recommend WW for a patient with a PSA of around 5 ng/mL and a Gleason
score of around 4 or 5 (the given scenario was a 65 years old man in good health, with negative
DRE and no evidence of nonlocalized disease), but almost none would recommend WW for
those with higher PSA or Gleason scores (Fowler 2000). 188 The responses of urologists and
radiation oncologists did not differ significantly.

Acceptance of AS

Age. Twelve multivariable analyses provided results for age with respect to
AS/WW. 66,77,159,161,162,166,171,174,175,177,179,180 All reported men who were older (generally aged 65
to 75 years) had an increased probability of receiving AS/WW versus active treatments.

Comorbidities. Five multivariable analyses reported that men with an increased number of
comorbidities also had an increased probability of receiving AS/WW versus active
treatments. 66,77,159,164-166 Two multivariable analyses did not find an association. 177,180

Gleason score. Three multivariable analyses reported that men with a higher Gleason score also
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had a decreased probability of receiving AS/WW versus any other treatment. 77,180 or RP.

Histopathology. Two multivariable analyses provided results for histopathology with respect to
AS/WW. 159,166 Both reported that men with well-differentiated, as compared to either moderately
or poorly differentiated, prostate tumors had an increased probability of receiving AS/WW
versus other treatments.

Stage. Three multivariable analyses reported that men with higher stage disease (local versus in
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situ; T2 versus T1 171,177 ) had a decreased probability of receiving AS/WW versus active
treatments.

PSA. Three multivariable analyses reported that men with increased PSA had a decreased
probability of receiving AS/WW versus active treatment. 77,171,177 One multivariable analysis of
men with high risk but nonmetastatic prostate cancer reported that higher PSA (>20 vs. ≤10
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ng/mL) was associated with increased probability of receiving AS/WW versus RP.

Risk groups. Two multivariable analyses reported that men assessed as D’Amico low-risk 200
(versus intermediate- or high-risk) had an increased probability of receiving AS/WW versus
active treatments. 66,161

medical oncologists were more likely than those seen by both urologists and radiation oncologists to receive
AS/WW (all ages combined: 26.3 percent or 34.1 percent vs. 4.6 percent, respectively; see original paper for age-
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stratified results). This study did not meet our multivariable analysis inclusion criterion.

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