Current use of active surveillance for localized prostate cancer: A nationwide survey in Japan

Objective: To understand the current practice pattern of active surveillance using a nationwide survey among Japanese urologists. Methods: A new questionnaire about active surveillance was developed and mailed to 863 training institutes in January 2014. The questionnaire included indications for active surveillance, percentage of active surveillance for localized prostate cancer, problems with active surveillance, which protocol was used, timing of first repeat biopsy, use of prostate-specific antigen or doubling time and use of magnetic resonance imaging. Results: A total of 2133 Japanese urologists in the 632 training institutes answered the questionnaire. The median age was 42years (26-84years). Of the responders, 26.9% had no use of active surveillance for localized prostate cancer. The Prostate Cancer Research International: Active Surveillance criteria were most frequently used (29.7%), followed by a low-risk group without a definitive follow-up protocol (29.4%). Regarding repeat biopsy, 40.6% carried it out at 1year after active surveillance initiation, but 24.1% did not usually carry it out and 31.8% carried it out only when they considered it necessary. Magnetic resonance imaging was used routinely in 22.2% and as required in 67.6%. Re-biopsy or magnetic resonance imaging was less carried out in general hospitals than in universities. The percentage of no usual repeat biopsy was significantly higher in urologists who had more than 10years of experience. Repeat biopsies (60.3%), inadequate inclusion criteria (49.9%), psychological burden for patients (43.7%), unexpected progression (41.1%) and unknown long-term outcomes (40.6%) were considered the major problems of active surveillance in the responders. Conclusions: The practice pattern of active surveillance varies widely among Japanese urologists. It is necessary to gain a correct understanding of active surveillance.