{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:25:54Z","timestamp":1793395554657,"version":"4.5.0"},"reference-count":27,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SJU"],"abstract":"<jats:p>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.\nMaterials 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.\nResults: 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.\nConclusions: 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.<\/jats:p>","DOI":"10.2340\/sju.v60.45023","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T11:59:43Z","timestamp":1765367983000},"page":"218-225","source":"Crossref","is-referenced-by-count":1,"title":["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"],"prefix":"10.2340","volume":"60","author":[{"given":"Ingrid","family":"Hannestad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tor \u00c5ge","family":"Myklebust","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie D.","family":"Foss\u00e5","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stig","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsti","family":"Aas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"135015","doi-asserted-by":"crossref","unstructured":"Choo R, Klotz L, Danjoux C, et al. Feasibility study: watchful waiting for localized low to intermediate grade prostate carcino-ma with selective delayed intervention based on prostate specific antigen, histological and\/or clinical progression. J Urol. 2002;167(4):1664\u20131669. https:\/\/doi.org\/10.1016\/S0022-5347(05)65174-9","DOI":"10.1016\/S0022-5347(05)65174-9"},{"key":"135016","unstructured":"Uroweb. Guidelines on prostate cancer: treatment [Internet]. Available from: https:\/\/uroweb.org\/guidelines\/prostate-cancer\/chapter\/treatment. [Accessed 8 June 2025]"},{"key":"135017","doi-asserted-by":"crossref","unstructured":"Bruinsma SM, Roobol MJ, Carroll PR, et al. Semantics in active surveillance for men with localized prostate cancer\u2014results of a modified Delphi consensus procedure. Nat Rev Urol. 2017;14(5):312\u2013322. https:\/\/doi.org\/10.1038\/nrurol.2017.26","DOI":"10.1038\/nrurol.2017.26"},{"key":"135018","doi-asserted-by":"crossref","unstructured":"Klotz L. Active surveillance in intermediate-risk prostate cancer. BJU Int. 2020;125(3):346\u2013354. https:\/\/doi.org\/10.1111\/bju.14935","DOI":"10.1111\/bju.14935"},{"key":"135019","doi-asserted-by":"crossref","unstructured":"Lam TBL, MacLennan S, Willemse P-PM, et al. EAU-EANM-ESTRO-ESUR-SIOG prostate cancer guideline panel consensus statements for Deferred Treatment with Curative Intent for Localised Prostate Cancer from an International Collaborative Study (DETECTIVE Study). Eur Urol. 2019;76(6):790\u2013813.","DOI":"10.1016\/j.eururo.2019.09.020"},{"key":"135020","doi-asserted-by":"crossref","unstructured":"Klotz L. Active surveillance for low-risk prostate cancer. Curr Opin Urol. 2017;27(3):225\u2013230. https:\/\/doi.org\/10.1097\/MOU.0000000000000393","DOI":"10.1097\/MOU.0000000000000393"},{"key":"135021","doi-asserted-by":"crossref","unstructured":"Komisarenko M, Martin LJ, Finelli A. Active surveillance review: contemporary selection criteria, follow-up, compliance and outcomes. Transl Androl Urol. 2018;7(2):243\u201355. https:\/\/doi.org\/10.21037\/tau.2018.03.02","DOI":"10.21037\/tau.2018.03.02"},{"key":"135022","doi-asserted-by":"crossref","unstructured":"Ahmad AE, Richard PO, Le\u00e3o R, et al. Does time spent on active surveillance adversely affect the pathological and oncologic outcomes in patients undergoing delayed radical prostatectomy? J Urol. 2020;204(3):476\u2013482. https:\/\/doi.org\/10.1097\/JU.0000000000001070","DOI":"10.1097\/JU.0000000000001070"},{"key":"135023","doi-asserted-by":"crossref","unstructured":"Soeterik TFW, van Melick HHE, Dijksman LM, et al. Follow-up in active surveillance for prostate cancer: strict protocol adher-ence remains important for PRIAS-ineligible patients. Eur Urol Oncol. 2019;2(5):483\u2013489. https:\/\/doi.org\/10.1016\/j.euo.2019.01.010","DOI":"10.1016\/j.euo.2019.01.010"},{"key":"135024","doi-asserted-by":"crossref","unstructured":"Soeterik TFW, van Melick HHE, Dijksman LM, et al. Active surveillance for prostate cancer in a real-life cohort: comparing outcomes for PRIAS-eligible and PRIAS-ineligible patients. Eur Urol Oncol. 2018;1(3):231\u2013237. https:\/\/doi.org\/10.1016\/j.euo.2018.03.015","DOI":"10.1016\/j.euo.2018.03.015"},{"key":"135025","unstructured":"Helsedirektoratet. Behandling med kurativ intensjon (Utsatt behandling) 2023 [Internet]. [updated 2024 Oct 2]. Available from: https:\/\/www.helsedirektoratet.no\/retningslinjer\/prostatakreft- handlingsprogram\/behandling-med-kurativ-intensjon\/utsatt- behandling."},{"key":"135026","unstructured":"Folkehelseinstituttet (FHI). \u00c5rsrapport 2022: Nasjonalt kvalitetsregister for prostatakreft. Folkehelseinstituttet (FHI); 2023: Oslo, Norway. Contract No.: 05 April."},{"key":"135027","doi-asserted-by":"crossref","unstructured":"S\u00f8rensen JB, Klee M, Palshof T, et al. Performance status assessment in cancer patients. An inter-observer variability study. Br J Cancer. 1993;67(4):773\u2013775. https:\/\/doi.org\/10.1038\/bjc.1993.140","DOI":"10.1038\/bjc.1993.140"},{"key":"135028","doi-asserted-by":"crossref","unstructured":"Nilssen Y, Strand TE, Wiik R, et al. Utilizing national patient-register data to control for comorbidity in prognostic studies. Clin Epidemiol. 2014;6:395\u2013404. https:\/\/doi.org\/10.2147\/CLEP.S70742","DOI":"10.2147\/CLEP.S70742"},{"key":"135029","doi-asserted-by":"crossref","unstructured":"Maljkovic J, Bill-Axelson A, H\u00e5llberg H, et al. Time trends for the use of active surveillance and deferred treatment for localised prostate cancer in Sweden: a nationwide study. Scand J Urol. 2024;59:200\u2013206. https:\/\/doi.org\/10.2340\/sju.v59.40123","DOI":"10.2340\/sju.v59.40123"},{"key":"135030","doi-asserted-by":"crossref","unstructured":"Orrason AW, Scilipoti P, Garmo H, et al. Improved adherence to prostate cancer guidelines concomitant with public reporting. Nationwide population-based study. Scand J Urol. 2025;60:50\u201358. https:\/\/doi.org\/10.2340\/sju.v60.43107","DOI":"10.2340\/sju.v60.43107"},{"key":"135031","doi-asserted-by":"crossref","unstructured":"Hamdy FC, Donovan JL, Lane JA, et al. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2023;388(17):1547\u20131558. https:\/\/doi.org\/10.1056\/NEJMoa2214122","DOI":"10.1056\/NEJMoa2214122"},{"key":"135032","doi-asserted-by":"crossref","unstructured":"Drost F-JH, Rannikko A, Valdagni R, et al. Can active surveillance really reduce the harms of overdiagnosing prostate cancer? A reflection of real life clinical practice in the PRIAS study. Transl Androl Urol. 2018;7(1):98\u2013105. https:\/\/doi.org\/10.21037\/tau.2017.12.28","DOI":"10.21037\/tau.2017.12.28"},{"key":"135033","doi-asserted-by":"crossref","unstructured":"Kalapara AA, Verbeek JFM, Nieboer D, et al. Adherence to active surveillance protocols for low-risk prostate cancer: results of the movember foundation\u2019s global action plan prostate cancer active surveillance initiative. Eur Urol Oncol. 2020;3(1):80\u201391.","DOI":"10.1016\/j.euo.2019.08.014"},{"key":"135034","doi-asserted-by":"crossref","unstructured":"Blagden SP, Charman SC, Sharples LD, et al. Performance status score: do patients and their oncologists agree? Br J Cancer. 2003;89(6):1022\u20131027. https:\/\/doi.org\/10.1038\/sj.bjc.6601231","DOI":"10.1038\/sj.bjc.6601231"},{"key":"135035","doi-asserted-by":"crossref","unstructured":"Westerberg M, Irenaeus S, Garmo H, et al. Development and validation of a multi-dimensional diagnosis-based comorbidity index that improves prediction of death in men with prostate cancer: nationwide, population-based register study. PLoS One. 2024;19(1):e0296804. https:\/\/doi.org\/10.1371\/journal.pone.0296804","DOI":"10.1371\/journal.pone.0296804"},{"key":"135036","doi-asserted-by":"crossref","unstructured":"Ventimiglia E, Gedeborg R, Orrason AW, et al. A comparison of comorbidity indices and estimates of life expectancy for men with prostate cancer. Scand J Urol. 2025;60:105\u2013107. https:\/\/doi.org\/10.2340\/sju.v60.43810","DOI":"10.2340\/sju.v60.43810"},{"key":"135037","doi-asserted-by":"crossref","unstructured":"Timilshina N, Komisarenko M, Martin LJ, et al. Factors associated with discontinuation of active surveillance among men with low-risk prostate cancer: a population-based study. J Urol. 2021;206(4):903\u2013913. https:\/\/doi.org\/10.1097\/JU.0000000000001903","DOI":"10.1097\/JU.0000000000001903"},{"key":"135038","doi-asserted-by":"crossref","unstructured":"Haug ES, Myklebust T, Julieb\u00f8-Jones P, et al. Impact of prebiopsy MRI on prostate cancer staging: results from the Norwegian Prostate Cancer Registry. BJUI Compass. 2023;4(3):331\u2013338. https:\/\/doi.org\/10.1002\/bco2.214","DOI":"10.1002\/bco2.214"},{"key":"135039","unstructured":"European Association of Urology. EAU guidelines on prostate cancer. European Association of Urology; 2018: Arnhem, The Netherlands."},{"key":"135040","doi-asserted-by":"crossref","unstructured":"Cooperberg MR, Meeks W, Fang R, et al. Time trends and variation in the use of active surveillance for management of low-risk prostate cancer in the US. JAMA Network Open. 2023;6(3):e231439-e. https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.1439","DOI":"10.1001\/jamanetworkopen.2023.1439"},{"key":"135041","doi-asserted-by":"crossref","unstructured":"Stattin P. How to improve cancer care by use of guidelines and quality registers. Scand J Urol. 2024;59:190\u2013192. https:\/\/doi.org\/10.2340\/sju.v59.42272","DOI":"10.2340\/sju.v59.42272"}],"container-title":["Scandinavian Journal of Urology"],"original-title":[],"link":[{"URL":"https:\/\/medicaljournalssweden.se\/SJU\/article\/download\/45023\/52221","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/medicaljournalssweden.se\/SJU\/article\/download\/45023\/52221","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T11:59:46Z","timestamp":1765367986000},"score":1,"resource":{"primary":{"URL":"https:\/\/medicaljournalssweden.se\/SJU\/article\/view\/45023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,10]]},"references-count":27,"URL":"https:\/\/doi.org\/10.2340\/sju.v60.45023","relation":{},"ISSN":["2168-1813"],"issn-type":[{"value":"2168-1813","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,10]]}}}