Page 122 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Adherence to AS

Age. Four multivariable analyses analyzed age with respect to interruption of
AS/WW. 164,168,175,176 Two found that men who were younger had an increased probability of
receiving definitive treatments, 168,175 and two found that age was not a factor. 164,176

Comorbidities. Three multivariable analyses reported that the number of comorbidities was not
associated with interruption of AS/WW. 164,175,176
Gleason score. Five multivariable analyses reported that Gleason score at diagnosis was not
associated with interruption of AS/WW. 168,172,174-176

Histopathology. No study analyzed histopathology to describe tumor differentiation with respect
to interruption of AS.

Stage. Three multivariable analyses reported that men with higher stage disease (T2 versus T1)
had an increased probability of interruption of AS/WW to seek secondary treatment. 168,175,176
One analysis reported that disease stage (T2 versus T1) was not a significant predictor of the
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receipt of curative treatment.

PSA. Two multivariable analyses reported that men with increased PSA at diagnosis also had an
increased probability of interruption of AS/WW to seek active treatments. 168,175 One analysis
reported that neither initial PSA nor PSA density was predictive of men who interrupted AS to
seek radical treatment, but the free to total PSA ratio was predictive of the probability of
interruption of AS. 172 One analysis reported that initial PSA was not predictive of men who
interrupted AS to seek definitive treatment, but that a short PSA doubling time was (< 2 yr vs. 2
to 5 yr). 176 Two other multivariable analyses also reported that increased PSA velocity during
followup was predictive of interruption of AS to seek active treatments. 164,174

Risk groups. One multivariable analysis reported that patients assessed as D’Amico low-risk
(versus intermediate- or high-risk) had a decreased probability of interruption of AS/WW to seek
active treatment, 167 while two reported that risk classification was not a significant predictor in
the interruption of AS/WW. 164,168

Patient Factors

Family Involvement
Offer of AS. No study or survey specifically addressed how family involvement might affect the
offer of AS.

Acceptance of AS. One survey reported that 19 percent of 654 men, 185 and another survey 9
percent of 231 men, 190 mentioned that advice from family and friends was the most influential
factor in reaching a treatment decision. In a content analysis of focus group or interview
discussion including a total of 44 men with localized prostate cancer, 20 men reported relying on
influential others (an individual whose illness experience and/or story had explicit influence on
the participant’s treatment decision) to make a treatment decision. 191 Of these 20 men, this
influential other caused one man to consider WW more strongly and one to more likely reject

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