EURURO Vol. 72 No. 4

534 656

Platinum Priority – Prostate Cancer
Editorial by Peter C. Albertsen on pp. 542–543 of this issue
Quantifying the Transition from Active Surveillance to
Watchful Waiting Among Men with Very Low-risk Prostate Cancer
Mieke Van Hemelrijck Hans Garmo , Lars Lindhagen Ola Bratt
Pa¨r Stattin Jan Adolfsson
a Cancer Epidemiology Group, Division of Cancer Studies, King’s College London, London, UK; bInstitute of Environmental Medicine, Karolinska Institute,
Stockholm, Sweden; c Regional Cancer Centre Uppsala, Akademiska Sjukhuset, Uppsala, Sweden; dUppsala Clinical Research Centre, Uppsala, Sweden;
e Department of Translational Medicine Urology, Division of Urological Cancer, Lund University, Lund, Sweden; f CamPARI Clinic, Department of Urology,
Cambridge University Hospitals, Cambridge, UK; g Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; hDepartment of Surgical and
Perioperative Sciences, Urology and Andrology, Umea˚ University Hospital, Umea˚, Sweden; i CLINTEC Department, Karolinska Institute, Stockholm, Sweden
available at
journal homepage:
Article info
Article history:
Accepted October 17, 2016
Associate Editor:
Giacomo Novara
Keywords:
Active surveillance
Prostate cancer
Watchful waiting
Comorbidity
Abstract
Background: Active surveillance (AS) is commonly used for men with low-risk prostate
cancer (PCa). When life expectancy becomes too short for curative treatment to be
beneficial, a change from AS to watchful waiting (WW) follows. Little is known about
this change since it is rarely documented in medical records.
Objective: To model transition from AS to WW and how this is affected by age and
comorbidity among men with very low-risk PCa.
Design, setting, and participants: National population-based healthcare registers were
used for analysis.
Outcome measurements and statistical analysis: Using data on PCa characteristics, age,
and comorbidity, a state transition model was created to estimate the probability of
changes between predefined treatments to estimate transition from AS to WW.
Results and limitations: Our estimates indicate that 48% of men with very low-risk PCa
starting AS eventually changed to WW over a life course. This proportion increased with
age at time of AS initiation. Within 10 yr from start of AS, 10% of men aged 55 yr and 50%
of men aged 70 yr with no comorbidity at initiation changed to WW. Our prevalence
simulation suggests that the number of men on WW who were previously on AS will
eventually stabilise after 30 yr. A limitation is the limited information from clinical
follow-up visits (eg, repeat biopsies).
Conclusions: We estimated that changes from AS to WW become common among men
with very low-risk PCa who are elderly. This potential change to WW should be
discussed with men starting on AS. Moreover, our estimates may help in planning
health care resources allocated to men on AS, as the transition to WW is associated with
lower demands on outpatient resources.
Patient summary: Changes from active surveillance to watchful waiting will become
more common among men with very low-risk prostate cancer. These observations
suggest that patients need to be informed about this potential change before they start
on active surveillance.
# 2016 European Association of Urology. Published by Elsevier B.V. This is an open
access article under the CC BY-NC-ND license
).
y These authors contributed equally to this work.
* Corresponding author. Cancer Epidemiology Group, Division of Cancer Studies, King’s College
London, Bermondsey Wing, Guy’s Hospital, London SE1 9RT, UK. Tel. +44 20 71887904.
E-mail address: (M. Van Hemelrijck).
0302-2838/# 2016 European Association of Urology. Published by Elsevier B.V. This is an open access article under the CC
BY-NC-ND license ).