Bashir Al Hussein Al Awamlh1, Karla V Ballman2, Xiaoyue Ma2, Jim C Hu1, Jonathan E Shoag3,4,5. 1. Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA. 2. Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA. 3. Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA. jes9171@med.cornell.edu. 4. University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA. jes9171@med.cornell.edu. 5. Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA. jes9171@med.cornell.edu.
Abstract
BACKGROUND: Concurrent with the decrease in the number of men diagnosed with prostate cancer (PCa), the proportion of men with low-risk PCa managed conservatively (active surveillance or watchful waiting) has increased in the United States. We aimed to determine whether this increase is a result of more men being managed conservatively or rather a higher proportion of the diminishing number of low-risk PCa managed this way. METHODS: The SEER "Prostate Watchful Waiting Database" identified men managed initially with conservative management between 2010 and 2016. Men > 40 years old who were diagnosed with low-risk (Gleason score 3 + 3, T1-T2a, PSA level < 10 ng/mL) PCa were included. Age-standardized and age-specific PCa incidence and conservative management rates were calculated per 100,000 man-years. The annual percent change in rates for the entire time period was also calculated. RESULTS: The incidence of low-risk PCa declined by 11.8% per year (95% confidence interval [CI] -15.4% to -8.0%), whereas the number of men assigned to conservative management for low-risk disease did not increase significantly, rising by +3.7% per year (95% CI -0.7% to 8.4%). In age-specific analysis, the number of men < 60 years and those who were 60-69 years managed conservatively increased by +9.6% per year (95% CI 2.7% to 16.9%) and 4.5% per year (95% CI 0.1% to 9.1%), respectively, whereas the number of men ≥ 70 years electing conservative management remained stable at -4% per year (95% CI -11.2% to 3.7%). CONCLUSIONS: The number of men electing conservative management has remained largely stable between 2010 and 2016, despite an increase in the proportion of low-risk PCa managed in this manner.
BACKGROUND: Concurrent with the decrease in the number of men diagnosed with prostate cancer (PCa), the proportion of men with low-risk PCa managed conservatively (active surveillance or watchful waiting) has increased in the United States. We aimed to determine whether this increase is a result of more men being managed conservatively or rather a higher proportion of the diminishing number of low-risk PCa managed this way. METHODS: The SEER "Prostate Watchful Waiting Database" identified men managed initially with conservative management between 2010 and 2016. Men > 40 years old who were diagnosed with low-risk (Gleason score 3 + 3, T1-T2a, PSA level < 10 ng/mL) PCa were included. Age-standardized and age-specific PCa incidence and conservative management rates were calculated per 100,000 man-years. The annual percent change in rates for the entire time period was also calculated. RESULTS: The incidence of low-risk PCa declined by 11.8% per year (95% confidence interval [CI] -15.4% to -8.0%), whereas the number of men assigned to conservative management for low-risk disease did not increase significantly, rising by +3.7% per year (95% CI -0.7% to 8.4%). In age-specific analysis, the number of men < 60 years and those who were 60-69 years managed conservatively increased by +9.6% per year (95% CI 2.7% to 16.9%) and 4.5% per year (95% CI 0.1% to 9.1%), respectively, whereas the number of men ≥ 70 years electing conservative management remained stable at -4% per year (95% CI -11.2% to 3.7%). CONCLUSIONS: The number of men electing conservative management has remained largely stable between 2010 and 2016, despite an increase in the proportion of low-risk PCa managed in this manner.
Authors: Brandon A Mahal; Santino Butler; Idalid Franco; Daniel E Spratt; Timothy R Rebbeck; Anthony V D'Amico; Paul L Nguyen Journal: JAMA Date: 2019-02-19 Impact factor: 56.272