Patterns of care and treatment trends for Canadian men with localized low-risk prostate cancer: an analysis of provincial cancer registry data

Abstract

Background: Many prostate cancers (pcas) are indolent and, if left untreated, are unlikely to cause death or morbidity in a man's lifetime. As a result of testing for prostate-specific antigen, more such cases are being identified, leading to concerns about "overdiagnosis" and consequent overtreatment of pca. To mitigate the risks associated with overtreatment (that is, invasive therapies that might cause harm to the patient without tangible benefit), approaches such as active surveillance are now preferred for many men with low-risk localized pca (specifically, T1/2a, prostate-specific antigen ≤ 10 ng/mL, and Gleason score ≤ 6). Here, we report on patterns of care and treatment trends for men with localized low-risk pca.

Results: The provinces varied substantially with respect to the types of primary treatment received by men with localized low-risk pca. From 2010 to 2013, many men had no record of surgical or radiation treatment within 1 year of diagnosis-a proxy for active surveillance; the proportion ranged from 53.3% in Nova Scotia to 80.8% in New Brunswick. Among men who did receive primary treatment, the use of radical prostatectomy ranged from 12.0% in New Brunswick to 35.9% in Nova Scotia. The use of radiation therapy (external-beam radiation therapy or brachytherapy) ranged from 4.1% in Newfoundland and Labrador to 17.6% in Alberta. Treatment trends over time suggest an increase in the use of active surveillance. The proportion of men with low-risk pca and no record of surgical or radiation treatment rose to 69.9% in 2013 from 46.1% in 2010 for all provinces combined.

Conclusions: The provinces varied substantially with respect to patterns of care for localized low-risk pca. Treatment trends over time suggest an increasing use of active surveillance. Those findings can further the discussion about the complex care associated with pca and identify opportunities for improvement in clinical practice.

Keywords: Prostate cancer; active surveillance; low-risk prostate cancer; patterns of care; radiation therapy; radical prostatectomy; treatment.

FIGURE 1

Percentages of men with low-risk prostate cancer receiving various types of treatment, by province, for the 2010–2013 diagnosis years combined. Data for all years are presented for Alberta, Saskatchewan, Manitoba, Nova Scotia, and Prince Edward Island; 2011–2013 data are presented for New Brunswick; and 2011–2012 data are presented for Newfoundland and Labrador. Because of small numbers, “RT [radiation therapy] only” and “Surgery with adjuvant RT” were combined for Manitoba, New Brunswick, and Prince Edward Island. Data source: Provincial cancer agencies. * Supressed because of small numbers. N/A = not applicable.

FIGURE 2

Percentage of men with low-risk prostate cancer receiving various types of treatment, by year, all provinces combined, 2010–2013 diagnosis years. “Provinces combined” in 2010 includes Alberta, Saskatchewan, Manitoba, Nova Scotia, and Prince Edward Island; in 2011 and 2012, it includes Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador; in 2013, it includes Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia, and Prince Edward Island. Radiation therapy (RT) data were available starting 1 January 2012 in New Brunswick. No treatment data were available from Newfoundland and Labrador for 2013 because of data issues. Because of small numbers in 2013, “RT only” and “Surgery with adjuvant RT” were combined. Data source: Provincial cancer agencies.