Quantifying the Transition from Active Surveillance to Watchful Waiting Among Men with Very Low-risk Prostate Cancer.
Active surveillance (AS) is commonly used for men with low-risk prostate cancer (PCa). When life expectancy becomes too short for curative treatment to be beneficial, a change from AS to watchful waiting (WW) follows. Little is known about this change since it is rarely documented in medical records.



To model transition from AS to WW and how this is affected by age and comorbidity among men with very low-risk PCa.



National population-based healthcare registers were used for analysis.



Using data on PCa characteristics, age, and comorbidity, a state transition model was created to estimate the probability of changes between predefined treatments to estimate transition from AS to WW.



Our estimates indicate that 48% of men with very low-risk PCa starting AS eventually changed to WW over a life course. This proportion increased with age at time of AS initiation. Within 10 yr from start of AS, 10% of men aged 55 yr and 50% of men aged 70 yr with no comorbidity at initiation changed to WW. Our prevalence simulation suggests that the number of men on WW who were previously on AS will eventually stabilise after 30 yr. A limitation is the limited information from clinical follow-up visits (eg, repeat biopsies).



We estimated that changes from AS to WW become common among men with very low-risk PCa who are elderly. This potential change to WW should be discussed with men starting on AS. Moreover, our estimates may help in planning health care resources allocated to men on AS, as the transition to WW is associated with lower demands on outpatient resources.



Changes from active surveillance to watchful waiting will become more common among men with very low-risk prostate cancer. These observations suggest that patients need to be informed about this potential change before they start on active surveillance.
Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK; Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden. Electronic address: mieke.vanhemelrijck@kcl.ac.uk.
Mieke
M
Van Hemelrijck
Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK; Regional Cancer Centre Uppsala, Akademiska Sjukhuset, Uppsala, Sweden.
Hans
H
Garmo
Uppsala Clinical Research Centre, Uppsala, Sweden.
Lars
L
Lindhagen
Department of Translational Medicine Urology, Division of Urological Cancer, Lund University, Lund, Sweden; CamPARI Clinic, Department of Urology, Cambridge University Hospitals, Cambridge, UK.
Ola
O
Bratt
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden.
Pär
P
Stattin
CLINTEC Department, Karolinska Institute, Stockholm, Sweden.
Jan
J
Adolfsson
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003198:Computer Simulation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D057832:Watchful Waiting
Active surveillance; Comorbidity; Prostate cancer; Watchful waiting