How widespread is active surveillance of early‐stage prostate cancer in Japan? Multicenter questionnaire survey on the status of active surveillance of early‐stage prostate cancer in Japan
Year: 2024
Type: article
Study design: Observational Study
Abstract: No nationwide statistics of localized prostate cancer (PCa) treatment in Japan have been reported since 2014. 1 In August 2023, we conducted a survey of cancer treatment facilities throughout Japan to assess the status of active surveillance (AS) by emailing to a questionnaire to Japan Clinical Oncology Group (JCOG) or Prostate Cancer Research International Active Surveillance 2 (PRIAS)-JAPAN (P-J) facilities.The questionnaire asked respondents to report the percentage of National Comprehensive Cancer Network (NCCN) patients with very low-to favorable intermediate-risk PCa who received AS.In Japan, P-J is conducting a prospective observational study of AS; therefore, P-J providers have a good understanding of patient eligibility for AS and are more committed to AS than other healthcare providers.We therefore decided to compare P-J facilities and non-P-J facilities.Furthermore, we compared the prevalence of AS between urban and rural areas, defined according to the number of patients living close to the facility.The medical area (MA) of each site was estimated using jSTAT MAP (https://jstatmap.e-stat.go.jp/map. html) to estimate the number of residents who could reach the facility within 30 min driving by car at 40 km/h.MAs were classified as small (population <800 000), medium (population 800 000-3 000 000), or large (population >3 000 000).The Mann-Whitney U-test and oneway analysis of variance (ANOVA) with Tukey's post hoc tests were used for two-and three-group comparisons, respectively, using GraphPad Prism 7.00 (GraphPad Software, San Diego, CA, USA).Fifty-one of 60 facilities (85%) responded (Figure 1a), including 15 JCOG-only, 7 P-Jonly, and 29 joint JCOG and P-J facilities.Eighteen, 20, and 13 facilities were located in small, medium, and large MAs, respectively.The median AS proportion by facility was 10% (interquartile range [IQR]; 10%-26%) (Figure 1b).The AS proportion did not differ between P-J (12.5%, IQR: 10%-26.5%)and JCOG-only (10%, IQR: 5%-30%) sites (p = 0.8), or between small (15%, IQR: 5%-30%), medium (20%, IQR: 10%-29.3%),and large (10%, IQR: 5%-20%) MAs (p = 0.3), suggesting that participation in P-J and area of residence do not have a major affect AS implementation.In this survey, the proportion of patients with early-stage prostate cancer receiving AS (10%) was similar to that reported in the last national survey in 2010 (12%).In a survey conducted in Europe in 2014, 3 the proportion of patients receiving AS was 91%, 74%, and 19% in very low-, low-, and intermediate-risk facilities, respectively.3 In a survey conducted in the United States in 2021, 4 approximately 60% of those at low risk received AS.Although AS is cost-effective 5 and maintains patients' quality of life, 6 the limited use in Japan compared with Western countries indicates overdiagnosis and overtreatment of early-stage PCa in Japan.This study has several limitations.The questionnaire was only sent to P-J and JCOG sites, which are generally university hospitals or large regional cancer centers; therefore, the status of AS implementation in small-and medium-sized hospitals could not be ascertained.Very low-to intermediate-risk categories were grouped to simplify the question about AS implementation.The hospitals included in the survey were high-volume centers that receive referrals of intermediate-risk cases.In Japan, AS of intermediate-risk cases started only recently and has not yet been widely implemented.A national treatment registry is needed to assess AS implementation in small-and medium-sized hospitals and by risk level.Some respondents commented in the free-response section of the questionnaire that patients were referred for curative therapy even if they were eligible for AS.This suggests that small facilities responsible for the initial consultation through to diagnosis may refer patients to larger hospitals for treatment without informing patients about the option of AS.AS monitors patients with localized cancer and requires sufficient time for shared decision-making.In 1438
Source: International Journal of Urology
DOI: 10.1111/iju.15573
Institutions: Kagawa University, Kagawa University Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4402287541