{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T07:57:04Z","timestamp":1790582224762,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate active surveillance (AS) continuation rates and associated clinical and institutional factors in Japanese patients with localized prostate cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 989 patients with localized prostate cancer from 92 institutions who initiated AS between 2016 and 2018. Institutions were categorized into three groups based on AS uptake for low\u2010risk disease. Discontinuation triggers and subsequent treatments were examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median age was 70\u2009years; 66.2%, 26.0%, and 7.8% of patients had low\u2010, intermediate\u2010, and high\u2010risk disease, respectively. Over a median follow\u2010up of 3.4\u2009years, 47.0% discontinued AS (median AS continuation time: 3.0\u2009years; 5\u2010year AS continuation rate: 33.7%). Multivariable analysis showed that \u2265\u20092 comorbidities, \u2265\u20093 positive biopsy cores, and T2b\u2013c stage were associated with restricted mean continuation time differences (RMCTDs) of \u22120.6, \u22120.6, and \u22120.8\u2009years, respectively (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Conversely, intermediate\u2010 and high\u2010AS uptake institutions had significantly longer adjusted RMCTD (1.0 and 1.1\u2009years, respectively; both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Triggers for discontinuation were more often multifaceted in high\u2010AS uptake institutions (39.1%) compared with low\u2010 or intermediate\u2010AS uptake institutions (16.2% and 15.1%, respectively). After discontinuation, 36.5%, 39.2%, and 24.3% of patients received prostatectomy, radiotherapy, and hormonal therapy, respectively. With advancing age, the proportion of patients whose AS was discontinued due to PSA elevation increased, as did the rate of subsequent hormonal therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In Japanese real\u2010world practice, AS continuation was limited. Beyond clinicopathological factors, institutional strategies for localized prostate cancer played a significant role in treatment choices following AS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iju.70642","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T18:05:16Z","timestamp":1789409116000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Clinicopathological and Institutional Factors on the Clinical Courses of Patients With Localized Prostate Cancer Initially Managed by Active Surveillance: An Analysis of Nationwide Real\u2010World Data From Japan"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9700-0274","authenticated-orcid":false,"given":"Mizuki","family":"Onozawa","sequence":"first","affiliation":[{"name":"Department of Urology International University of Health and Welfare Narita Hospital  Narita 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