Long-term Outcomes Among Men Undergoing Active Surveillance for Prostate Cancer in Sweden.

• The long-term outcomes among men with prostate cancer (PC) whose disease is managed with active surveillance (AS) remains unknown.To develop a simulation model with a 30-year follow-up for men with PC managed with AS.In this cohort study, a state transition model was created using data from Prostate Cancer data Base Sweden (PCBaSe) on 23655 men diagnosed with PC and managed with deferred treatment to estimate treatment trajectories. A simulation was performed with 100000 men in each combination of age at diagnosis, Charlson Comorbidity Index, and PC risk with a follow-up of 30 years.Death from PC and death from other causes were estimated, and the proportion of time without active PC treatment was assessed until date of death or age 85 years.This study included 23655 men from PCBaSe with a median age at diagnosis of 69 years (IQR, 64-74 years). Of these, 16177 men underwent active surveillance for PC and 7478 underwent watchful waiting. The proportion of men who were diagnosed at age 55 years and died of PC before age 85 years was 9% for very low-risk PC, 13% for low-risk PC, and 15% for intermediate-risk PC. Among men with a Charlson Comorbidity Index of 0 who were diagnosed at age 70 years, the corresponding percentages were 3%, 6%, and 7%, respectively. The mean proportion of remaining life-years without active PC treatment for men diagnosed at age 55 years was 12 of 25 years (48%) for very low-risk PC, 9 of 25 years (36%) for low-risk PC, and 7 of 25 (29%) for intermediate-risk PC. For men aged 70 years, the corresponding numbers were 10 of 13 years (77%), 9 of 13 years (66%), and 8 of 13 years (60%), respectively. Men with intermediate-risk PC who were younger than 60 years at diagnosis had a high risk of PC death (12%-15%) and fewer remaining life-years without active PC treatment (29%-33%). In contrast, men with low-risk PC who were older than 65 years at diagnosis had a lower risk of PC death (3%-5%) and more remaining life-years without active PC treatment (62%-77%).The findings of this Swedish cohort study suggest that active surveillance may be a safe strategy for disease management among men with PC who were older than 65 years at diagnosis.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Njurmedicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Nephrology (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)

Nyckelord

Aged

Cohort Studies

Humans

Male

Middle Aged

Prostatic Neoplasms

diagnosis

epidemiology

therapy

Risk

Sweden

epidemiology

Watchful Waiting

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