ArticleCanadian Urological Association journal = Journal de l'Association des urologues du Canada2025
Using real-world, population-level data to assess the uptake of active surveillance for low-grade prostate cancer before and after the release of clinical guidelines.
Article in Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Is uptake of AS in low-risk prostate cancer in Ontario linked to guideline publication?Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2025Article
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionClinical guidelines recommend active surveillance (AS) as the preferred strategy for men with localized grade group (GG) 1 prostate cancer (PCa). We determined if the percentage of GG1 PCa patients in Ontario, Canada, managed by AS changed after the introduction of AS clinical guidelines and assessed adherence to the recommended followup protocol.
methodsUsing Ontario administrative databases, we conducted a time series analysis (autoregressive integrated moving average [ARIMA] models) in a population-based cohort of men diagnosed with GG1 PCa (2010-2018). Men were classified as managed by AS if they had repeat (confirmatory) biopsy within two years. Sensitivity analyses (treatment classification variation) and secondary analyses (low-risk GG1 and GG2 PCa) were conducted.
resultsWe identified 12 236 eligible GG1 PCa patients, of which 7749 (63.3%) were initially managed by AS. Percentage AS increased from 44% in 2010 to 81% in 2018. Interrupted time series analysis estimated an immediate step change of 6.2 percentage points (95% confidence interval [CI] 3.0, 9.4) and a difference in slope of -2.3 percentage points (95% CI -6.9, 2.3) per year. Findings were robust to sensitivity analyses and similar for low-risk PCa. Adherence to monitoring and AS uptake in GG2 patients were not associated with guideline publication. Limitations include lack of treatment intent information in administrative data.
conclusionsThe use of AS for low-grade PCa patients in Ontario increased from almost one in two patients in 2010 to four in five patients in 2017/2018. Adoption appeared to reflect the growing acceptance of AS prior to the guidelines, as well as an increase in response to the guideline introduction.
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