Exploring the risk of overtreatment in older men with prostate cancer: a descriptive analysis of active surveillance




Madsen, Lydia Torian

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NCCN guidelines recommend active surveillance as the most appropriate treatment for individuals with disease classified as very low' risk or low' risk, to minimize the risk of over-treatment (NCCN Policy Update, 2013). In a senior prostate cancer population, recommendation for active surveillance may be particularly applicable given the risk of death from competing comorbidities. Disease characteristics, treatment recommendations and treatment decisions were retrospectively examined in a population of senior men, age 75 and older that were newlydiagnosed with organ confined prostate cancer. These men presented in a senior multidisciplinary prostate cancer clinic for treatment recommendations and were offered Active Surveillance as treatment. To characterize competing comorbidities, the Adult Comorbidities Evaluation (ACE-27) was retrospectively coded for each patient, in addition to counting comorbidities disclosed during the PME. Patient self-rated heath status was also included. 137 men, ages 75 to 88 were included in the analysis. Each patient was seen by a medical oncologist and a radiation oncologist, or by a radiation oncologist and a urologist. After detailed consultation with the multidisciplinary team, patients routinely received either a list of treatment options or a consensus recommendation from the team. We conclude that the consensus recommendation statement is a highly significant aspect to patients' selection of active surveillance, with a statistical effect size of 11.7, and that the decision to accept active surveillance is facilitated by the multidisciplinary clinic process.



Prostate cancer, Older men, Overtreatment, Active surveillance