Active surveillance for localized prostate cancer: An analysis of patient contacts and utilization of healthcare resources

TY - JOUR

T1 - Active surveillance for localized prostate cancer

T2 - An analysis of patient contacts and utilization of healthcare resources

AU - Thomsen, Frederik B

AU - Berg, Kasper D

AU - Røder, M Andreas

AU - Iversen, Peter

AU - Brasso, Klaus

PY - 2015/2/1

Y1 - 2015/2/1

N2 - OBJECTIVE: Evidence supports active surveillance (AS) as a means to reduce overtreatment of low-risk prostate cancer (PCa). The consequences of close and long-standing follow-up with regard to outpatient visits, tests and repeated biopsies are widely unknown. This study investigated the trajectory and costs of AS in patients with localized PCa.MATERIALS AND METHODS: In total, 317 PCa patients were followed in a prospective, single-arm AS cohort. The primary outcomes were number of patient contacts, prostate-specific antigen (PSA) tests, biopsies, hospital admissions due to biopsy complications and patients eventually undergoing curative treatment. The secondary outcome was cost.RESULTS: The 5 year cumulative incidence of discontinued AS in a competing-risk model was 40%. During the first 5 years of AS patients underwent a median of two biopsy sets, and patients were seen in an outpatient clinic including PSA testing three to four times annually. In total, 38 of the 406 biopsy sessions led to hospital admission and 87 of the 317 patients required treatment for bladder outlet obstruction (BOO). With a median of 3.7 years' follow-up, the total cost of AS was euro (€) 1,240,286. Assuming all patients had otherwise undergone primary radical prostatectomy, the cost difference favoured AS with a net benefit of €662,661 (35% reduction).CONCLUSIONS: AS entails a close clinical follow-up with a considerable risk of rebiopsy complication, treatment of BOO and subsequent delayed definitive therapy. This risk should be weighed against a potential economic benefit and reduction in the risk of overtreatment compared to immediate radical treatment.

AB - OBJECTIVE: Evidence supports active surveillance (AS) as a means to reduce overtreatment of low-risk prostate cancer (PCa). The consequences of close and long-standing follow-up with regard to outpatient visits, tests and repeated biopsies are widely unknown. This study investigated the trajectory and costs of AS in patients with localized PCa.MATERIALS AND METHODS: In total, 317 PCa patients were followed in a prospective, single-arm AS cohort. The primary outcomes were number of patient contacts, prostate-specific antigen (PSA) tests, biopsies, hospital admissions due to biopsy complications and patients eventually undergoing curative treatment. The secondary outcome was cost.RESULTS: The 5 year cumulative incidence of discontinued AS in a competing-risk model was 40%. During the first 5 years of AS patients underwent a median of two biopsy sets, and patients were seen in an outpatient clinic including PSA testing three to four times annually. In total, 38 of the 406 biopsy sessions led to hospital admission and 87 of the 317 patients required treatment for bladder outlet obstruction (BOO). With a median of 3.7 years' follow-up, the total cost of AS was euro (€) 1,240,286. Assuming all patients had otherwise undergone primary radical prostatectomy, the cost difference favoured AS with a net benefit of €662,661 (35% reduction).CONCLUSIONS: AS entails a close clinical follow-up with a considerable risk of rebiopsy complication, treatment of BOO and subsequent delayed definitive therapy. This risk should be weighed against a potential economic benefit and reduction in the risk of overtreatment compared to immediate radical treatment.

KW - Aged

KW - Ambulatory Care

KW - Biopsy, Large-Core Needle

KW - Cohort Studies

KW - Denmark

KW - Disease Management

KW - Disease Progression

KW - Health Resources

KW - Hospitalization

KW - Humans

KW - Kallikreins

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Prostate-Specific Antigen

KW - Prostatic Neoplasms

KW - Transurethral Resection of Prostate

KW - Watchful Waiting

U2 - 10.3109/21681805.2014.970572

DO - 10.3109/21681805.2014.970572

M3 - Journal article

C2 - 25363612

SN - 2168-1805

VL - 49

SP - 43

EP - 50

JO - Scandinavian Journal of Urology

JF - Scandinavian Journal of Urology

IS - 1

ER -