title: The uptake of active surveillance for the management of prostate cancer: A population-based analysis.
abstract: BACKGROUND
  Active surveillance (AS) is a strategy for the management of low-risk prostate cancer (PCa). However, few studies have assessed the uptake of AS at a population level and none of these were based on a Canadian population. Therefore, our objectives were to estimate the proportion of men being managed by AS in Ontario and to assess the factors associated with its uptake.
  
  
  METHODS
  This was a retrospective, population-based study using administrative databases from the province of Ontario to identify men ≤75 years diagnosed with localized PCa between 2002 and 2010. Descriptive statistics were used to estimate the proportion of men managed by AS, whereas mixed models were used to assess the factors associated with the uptake of AS.
  
  
  RESULTS
  45 691 men met our inclusion criteria. Of these, 18% were managed by AS. Over time, the rates of AS increased significantly from 11% to 21% (p<0.001). Older age, residing in an urban centre, being diagnosed in the later years of the study period, having a neighborhood income in the highest quintile, and being managed by urologists were all associated with greater odds of receiving AS.
  
  
  CONCLUSIONS
  There has been a steady increase in the uptake of AS between 2002 and 2010. However, only 18% of men diagnosed with localized PCa were managed by AS during the study period. The decisions to adopt AS were influenced by several individual and physician characteristics. The data suggest that there is significant opportunity for more widespread adoption of AS.
authors: Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto;; Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke and the University of Sherbrooke, Sherbrooke, QC, Canada.
authors: Patrick O
authors: PO
authors: Richard
authors: Department of Medicine, University Health Network and the University of Toronto.
authors: Shabbir M H
authors: SM
authors: Alibhai
authors: Biostatistics Department, Princess Margaret Hospital, University Health Network and the University of Toronto.
authors: Tony
authors: T
authors: Panzarella
authors: Division of Urology, Sunnybrook Health Sciences Centre and the University of Toronto.
authors: Laurence
authors: L
authors: Klotz
authors: Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto.
authors: Maria
authors: M
authors: Komisarenko
authors: Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto.
authors: Neil E
authors: NE
authors: Fleshner
authors: Department of Surgery, University Health Network and the University of Toronto; Toronto, ON, Canada.
authors: David
authors: D
authors: Urbach
authors: Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto.
authors: Antonio
authors: A
authors: Finelli