Abstract：
BACKGROUND: Active surveillance (AS) is the preferred strategy for low-risk prostate cancer (LRPC); however, limited data on determinants of AS adoption exist, particularly among Black men.
METHODS: Black and White newly diagnosed (from January 2014 through June 2017) patients with LRPC ≤75 years of age were identified through metro-Detroit and Georgia population-based cancer registries and completed a survey evaluating factors influencing AS uptake.
RESULTS: Among 1688 study participants, 57% chose AS (51% of Black participants, 61% of White) over definitive treatment. In the unadjusted analysis, patient factors associated with initial AS uptake included older age, White race, and higher education. However, after adjusting for covariates, none of these factors was significant predictors of AS uptake. The strongest determinant of AS uptake was the AS recommendation by a urologist (adjusted prevalence ratio, 6.59, 95% CI, 4.84-8.97). Other factors associated with the decision to undergo AS included a shared patient-physician treatment decision, greater prostate cancer knowledge, and residence in metro-Detroit compared with Georgia. Conversely, men whose decision was strongly influenced by the desire to achieve \"cure\" or \"live longer\" with treatment and those who perceived their LRPC diagnosis as more serious were less likely to choose AS.
CONCLUSIONS: In this contemporary sample, the majority of patients with newly diagnosed LRPC chose AS. Although the input from their urologists was highly influential, several patient decisional and psychological factors were independently associated with AS uptake. These data shed new light on potentially modifiable factors that can help further increase AS uptake among patients with LRPC.
METHODS: Black and White newly diagnosed (from January 2014 through June 2017) patients with LRPC ≤75 years of age were identified through metro-Detroit and Georgia population-based cancer registries and completed a survey evaluating factors influencing AS uptake.
RESULTS: Among 1688 study participants, 57% chose AS (51% of Black participants, 61% of White) over definitive treatment. In the unadjusted analysis, patient factors associated with initial AS uptake included older age, White race, and higher education. However, after adjusting for covariates, none of these factors was significant predictors of AS uptake. The strongest determinant of AS uptake was the AS recommendation by a urologist (adjusted prevalence ratio, 6.59, 95% CI, 4.84-8.97). Other factors associated with the decision to undergo AS included a shared patient-physician treatment decision, greater prostate cancer knowledge, and residence in metro-Detroit compared with Georgia. Conversely, men whose decision was strongly influenced by the desire to achieve \"cure\" or \"live longer\" with treatment and those who perceived their LRPC diagnosis as more serious were less likely to choose AS.
CONCLUSIONS: In this contemporary sample, the majority of patients with newly diagnosed LRPC chose AS. Although the input from their urologists was highly influential, several patient decisional and psychological factors were independently associated with AS uptake. These data shed new light on potentially modifiable factors that can help further increase AS uptake among patients with LRPC.
摘要：
背景：主动监测（AS）是低风险前列腺癌（LRPC）的首选策略；但是，关于AS采用的决定因素的数据有限，尤其是黑人。
方法：从2014年1月至2017年6月，新诊断的LRPC≤75岁的黑人和白人患者通过Metro-Detroit和Georgia基于人群的癌症登记处进行鉴定，并完成一项调查，评估影响AS摄取的因素。
结果：在1688名研究参与者中，57%的人选择了AS(51%的黑人参与者，61%的白色）超过最终治疗。在未经调整的分析中，与初始AS摄取相关的患者因素包括年龄较大，白人种族,和高等教育。然而,在调整协变量后，这些因素均不是AS摄取的显著预测因子。AS摄取的最强决定因素是泌尿科医师推荐的AS（调整后的患病率比率，6.59，95%CI，4.84-8.97）。与接受AS的决定相关的其他因素包括共同的患者-医生治疗决定，更多的前列腺癌知识，与佐治亚州相比，底特律地铁和住宅。相反，那些决定受到“治愈”或“寿命更长”的渴望强烈影响的男性，以及那些认为他们的LRPC诊断更严重的男性，选择AS的可能性较小。
结论：在这个当代样本中，大多数新诊断的LRPC患者选择了AS。尽管他们的泌尿科医生的投入非常有影响力，一些患者的决策和心理因素与AS摄取独立相关.这些数据为可能改变的因素提供了新的思路，这些因素可以帮助进一步增加LRPC患者的AS摄取。
方法：从2014年1月至2017年6月，新诊断的LRPC≤75岁的黑人和白人患者通过Metro-Detroit和Georgia基于人群的癌症登记处进行鉴定，并完成一项调查，评估影响AS摄取的因素。
结果：在1688名研究参与者中，57%的人选择了AS(51%的黑人参与者，61%的白色）超过最终治疗。在未经调整的分析中，与初始AS摄取相关的患者因素包括年龄较大，白人种族,和高等教育。然而,在调整协变量后，这些因素均不是AS摄取的显著预测因子。AS摄取的最强决定因素是泌尿科医师推荐的AS（调整后的患病率比率，6.59，95%CI，4.84-8.97）。与接受AS的决定相关的其他因素包括共同的患者-医生治疗决定，更多的前列腺癌知识，与佐治亚州相比，底特律地铁和住宅。相反，那些决定受到“治愈”或“寿命更长”的渴望强烈影响的男性，以及那些认为他们的LRPC诊断更严重的男性，选择AS的可能性较小。
结论：在这个当代样本中，大多数新诊断的LRPC患者选择了AS。尽管他们的泌尿科医生的投入非常有影响力，一些患者的决策和心理因素与AS摄取独立相关.这些数据为可能改变的因素提供了新的思路，这些因素可以帮助进一步增加LRPC患者的AS摄取。
