Prostate cancer (PCa) screening has led to an increased diagnosis of low-risk PCa. Active surveillance (AS) has been introduced to reduce overtreatment in men with low risk PCa. There is a large body of evidence that AS is safe and therefore, current guidelines recommend AS as the primary treatment option for patients with low risk PCa. Despite the current evidence and guideline recommendation, the use of AS still varies. The aim of the present study was to investigate the use of AS in the Canton of Zurich, Switzerland over a period of 9 years. The results were compared to those from the tertiary academic center (USZ) of the Canton Zurich, where all PCa patients were discussed in an interdisciplinary tumorboard.
Data were received from the cancer registry in Zurich between 2009 and 2018. All men with newly diagnosed low risk PCa, defined as primary ISUP Grade 1 (Gleason Score 3+3=6) cancer, living in the canton of Zurich, were included. Clinical data (PSA, clinical T-Stage, biopsy results) as well as the performed treatment were recorded. The use of AS was analyzed overall and for each observed year.
A total of 3393 men with low risk PCa were included in this study (canton Zurich: n=3131, USZ: n=262,). In the canton and USZ cohort 502 patients (16%) and 146 (55.7 %) men underwent AS, respectively. Local treatment (2220 (71%) vs. 115 (43.9%)), systemic treatment (43 (1.4%), vs. 0 (0%)) and unknown treatment (409 (13.0%) vs. 1 (0.38%)) were all distinctly higher in the canton Zurich compared to the USZ cohort. The uptake of AS over the years was only marginal in the canton (12.2% in 2009, 16.2% in 2018), whereas a strong uptake of AS in the USZ cohort was seen (35.4% in 2009, 88.2% in 2018), what resulted in almost 90% AS at the end of the observed time period.
AS is low in the canton of Zurich and has not relevantly increased over the observed period as against from clear guideline recommendations for low risk PCa. In our academic hospital, the use of AS was already considerably higher in 2009 and increased further to almost 90% over the years. Continuous education in the urology community is needed for better adherence to clinical guidelines for low risk PCa. Men with low risk PCa should seek a second opinion in a center with access to an interdisciplinary tumorboard.