Karim Chamie1, Stephen B Williams2, Dawn L Hershman3, Jason D Wright4,5,6, Paul L Nguyen7, Jim C Hu8. 1. Department of Urology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California. 2. Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 3. Department of Medical Oncology and Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York. 4. Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York. 5. Department of Medicine and Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York. 6. Department of Epidemiology, Mailman School of Public Health, Columbia University and New York Presbyterian Hospital, New York, New York. 7. Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts. 8. Department of Urology, Weill-Cornell Medical College, New York, New York.
Abstract
BACKGROUND: Despite recent interest in the overdiagnosis and overtreatment of prostate cancer, the acceptance of expectant management for patients with indolent prostate cancer has remained slow. Moreover, the intensity of surveillance strategies remains to be elucidated. The objective of this study was to determine the population-based intensity of surveillance strategy among patients diagnosed with localized prostate cancer who undergo watchful waiting/active surveillance and those who receive active treatment. METHODS: Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data were used to identify men diagnosed with prostate cancer from 2004 to 2007 who were followed until December 31, 2009. Bivariate and multivariate regression analyses were used to quantify the use of prostate-specific antigen tests, office visits, and second prostate biopsies within 2 years of diagnosis. RESULTS: Compared with patients who were receiving active treatment, those who were undergoing watchful waiting/active surveillance were less likely to receive prostate-specific antigen testing and to attend office visits within the 2 years after diagnosis (P < .01). Of the 3656 patients who were undergoing watchful waiting/active surveillance, only 166 (4.5%) were on active surveillance (according to the authors' a priori definition), although the number increased over the last 2 years of the study (hazard ratio, 2.18; 95% confidence interval, 1.28-3.71; P < .01). Limitations of the study included data limited to men aged 65 years or older and the lack of ability to discern between watchful waiting and active surveillance. CONCLUSIONS: Active surveillance is underused, and there is uncertainty regarding the quality of surveillance for patients who undergo watchful waiting/active surveillance. Further research is needed into qualitatively describing the contributing factors that drive decision-making recommendations as well as improved surveillance measures for patients with prostate cancer.
BACKGROUND: Despite recent interest in the overdiagnosis and overtreatment of prostate cancer, the acceptance of expectant management for patients with indolent prostate cancer has remained slow. Moreover, the intensity of surveillance strategies remains to be elucidated. The objective of this study was to determine the population-based intensity of surveillance strategy among patients diagnosed with localized prostate cancer who undergo watchful waiting/active surveillance and those who receive active treatment. METHODS: Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data were used to identify men diagnosed with prostate cancer from 2004 to 2007 who were followed until December 31, 2009. Bivariate and multivariate regression analyses were used to quantify the use of prostate-specific antigen tests, office visits, and second prostate biopsies within 2 years of diagnosis. RESULTS: Compared with patients who were receiving active treatment, those who were undergoing watchful waiting/active surveillance were less likely to receive prostate-specific antigen testing and to attend office visits within the 2 years after diagnosis (P < .01). Of the 3656 patients who were undergoing watchful waiting/active surveillance, only 166 (4.5%) were on active surveillance (according to the authors' a priori definition), although the number increased over the last 2 years of the study (hazard ratio, 2.18; 95% confidence interval, 1.28-3.71; P < .01). Limitations of the study included data limited to men aged 65 years or older and the lack of ability to discern between watchful waiting and active surveillance. CONCLUSIONS: Active surveillance is underused, and there is uncertainty regarding the quality of surveillance for patients who undergo watchful waiting/active surveillance. Further research is needed into qualitatively describing the contributing factors that drive decision-making recommendations as well as improved surveillance measures for patients with prostate cancer.
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