Marco Moschini1, Nicola Fossati2, Akshay Sood3, Justin K Lee4, Jesse Sammon3, Maxine Sun5, Dan Pucheril3, Deepansh Dalela3, Francesco Montorsi6, R Jeffrey Karnes7, Alberto Briganti6, Quoc-Dien Trinh8, Mani Menon3, Firas Abdollah9. 1. Department of Urology, Vita Salute San Raffaele University, Milan, Italy; Department of Urology, Mayo Clinic, Rochester, MN, USA. 2. Department of Urology, Vita Salute San Raffaele University, Milan, Italy; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 3. Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, Detroit, MI, USA. 4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 5. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. 6. Department of Urology, Vita Salute San Raffaele University, Milan, Italy. 7. Department of Urology, Mayo Clinic, Rochester, MN, USA. 8. Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA. 9. Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, Detroit, MI, USA. Electronic address: firas.abdollah@gmail.com.
Abstract
BACKGROUND: Active surveillance (AS) is increasingly recognized as a recommended treatment option for prostate cancer (PCa) patients with clinically localized, low-risk disease; however, previous studies suggested that its utilization is uncommon in the United States. OBJECTIVE: We evaluated the nationwide utilization rate of AS in the contemporary era. DESIGN, SETTING, AND PARTICIPANTS: We relied on the 2010-2011 Surveillance Epidemiology and End Results (SEER) database using all 18 SEER-based registries. We identified 9049 patients that fulfilled the University of California, San Francisco AS criteria (prostate-specific antigen level <10ng/ml, clinical T stage ≤2a, Gleason score ≤6 [no pattern 4 or 5], and percentage of positive biopsy cores <33%). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Logistic regression analysis tested the relationship between receiving local treatment and all available predictors. RESULTS AND LIMITATIONS: Only 32% of AS candidates did not receive any active local treatment. This proportion varied widely among the SEER-based registries, ranging from 13% to 49% (p<0.001). In multivariable analyses, clinical stage T2a (odds ratio [OR]: 1.23; p=0.04) and percentage of positive cores (OR: 1.10 for each 2% increase; p<0.001) were associated with a higher probability of receiving local treatment. Conversely, older age (OR: 0.89 for each 2-yr increase; p<0.001), not being married (OR: 0.64; p<0.001), and uninsured status (OR: 0.55; p=0.008) were associated with a lower probability of receiving active local treatment. The study is limited by the fact that SEER does not distinguish among patients undergoing observation, AS, watchful waiting, or initial hormonal therapy. CONCLUSIONS: In the United States, a considerable proportion of patients suitable for AS receive local treatment for PCa. Proportions differ significantly among SEER registries. PATIENT SUMMARY: Having more extensive and palpable disease, having medical insurance, being married, and being younger are associated with an increased probability of receiving local treatment for low-risk prostate cancer.
BACKGROUND: Active surveillance (AS) is increasingly recognized as a recommended treatment option for prostate cancer (PCa) patients with clinically localized, low-risk disease; however, previous studies suggested that its utilization is uncommon in the United States. OBJECTIVE: We evaluated the nationwide utilization rate of AS in the contemporary era. DESIGN, SETTING, AND PARTICIPANTS: We relied on the 2010-2011 Surveillance Epidemiology and End Results (SEER) database using all 18 SEER-based registries. We identified 9049 patients that fulfilled the University of California, San Francisco AS criteria (prostate-specific antigen level <10ng/ml, clinical T stage ≤2a, Gleason score ≤6 [no pattern 4 or 5], and percentage of positive biopsy cores <33%). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Logistic regression analysis tested the relationship between receiving local treatment and all available predictors. RESULTS AND LIMITATIONS: Only 32% of AS candidates did not receive any active local treatment. This proportion varied widely among the SEER-based registries, ranging from 13% to 49% (p<0.001). In multivariable analyses, clinical stage T2a (odds ratio [OR]: 1.23; p=0.04) and percentage of positive cores (OR: 1.10 for each 2% increase; p<0.001) were associated with a higher probability of receiving local treatment. Conversely, older age (OR: 0.89 for each 2-yr increase; p<0.001), not being married (OR: 0.64; p<0.001), and uninsured status (OR: 0.55; p=0.008) were associated with a lower probability of receiving active local treatment. The study is limited by the fact that SEER does not distinguish among patients undergoing observation, AS, watchful waiting, or initial hormonal therapy. CONCLUSIONS: In the United States, a considerable proportion of patients suitable for AS receive local treatment for PCa. Proportions differ significantly among SEER registries. PATIENT SUMMARY: Having more extensive and palpable disease, having medical insurance, being married, and being younger are associated with an increased probability of receiving local treatment for low-risk prostate cancer.
Authors: Richard M Hoffman; Tania Lobo; Stephen K Van Den Eeden; Kimberly M Davis; George Luta; Amethyst D Leimpeter; David Aaronson; David F Penson; Kathryn Taylor Journal: Med Decis Making Date: 2019-10-21 Impact factor: 2.583
Authors: Richard M Hoffman; Sarah L Mott; Bradley D McDowell; Sonia T Anand; Kenneth G Nepple Journal: Prostate Cancer Prostatic Dis Date: 2021-06-09 Impact factor: 5.455