Real-world implementation and guideline adherence at inclusion of active surveillance for men with prostate cancer: a population-based study from the Cancer Registry of Norway.

OBJECTIVES

This study aimed to evaluate the implementation of and adherence to national guidelines at inclusion amongst men with newly diagnosed prostate cancer (PCa) managed with active surveillance (AS) in Norway.

MATERIALS AND

METHODS

We conducted a population-based cohort study using data from the Norwegian Prostate Cancer Registry, encompassing all men diagnosed with PCa and managed with AS from 2009 to 2022. We assessed guideline adherence based on AS inclusion criteria defined in the national guidelines and analysed the factors associated with adherence. Non-adherence was defined as inclusion in AS despite not meeting formal criteria.

RESULTS

Among 69,996 men diagnosed with PCa, 11 449 (16.4%) were managed with AS. Overall adherence to national guidelines for AS inclusion was 64%, rising from 60% in 2009 to 77% in 2022, with a notable increase after the 2020 guideline update. Higher adherence was associated with more recent diagnoses, younger age, lower Eastern Cooperative Oncology Group (ECOG) performance status, and evaluation by a private specialist. Significant regional variations in guidelines adherence were observed.

CONCLUSIONS

While the use of AS for localised PCa increased in Norway over time, only two in three men were eligible for AS and regional variations persisted. This study highlights the need for strategies to standardise AS implementation across healthcare settings to ensure uniform and evidence-based management of patients with localised PCa nationwide.