Udit Singhal1, Jeffrey J Tosoian2, Ji Qi3, David C Miller2, Susan M Linsell3, Michael Cher4, Brian Lane5, Michael Cotant6, James E Montie2, Wassim Bazzi7, Mohammad Jafri8, Bradley Rosenberg8, Arvin K George2. 1. Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI. Electronic address: usinghal@med.umich.edu. 2. Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI. 3. Department of Urology, University of Michigan, Ann Arbor, MI. 4. Department of Urology, Karmanos Cancer Center, Wayne State University, Detroit, MI. 5. Department of Urology, Spectrum Health, Grand Rapids, MI. 6. War Memorial Hospital, Sault Ste. Marie, MI. 7. Michigan Institute of Urology, Troy, MI. 8. Department of Urology, Comprehensive Medical Center, Royal Oak, MI.
Abstract
OBJECTIVE: To determine rates of watchful waiting (WW) vs treatment in prostate cancer (PCa) and limited life expectancy (LE) and assess determinants of management. MATERIALS AND METHODS: Patients diagnosed with PCa between 2012 and 2018 with <10 years LE were identified from the Michigan Urologic Surgery Improvement Collaborative registry. Multinomial logistic regression models were used to identify factors associated with management choice among NCCN low-risk PCa patients. Data from high-volume practices were analyzed to understand practice variation. RESULTS: Total 2393 patients were included. Overall, WW was performed in 8.1% compared to 23.3%, 25%, 11.2%, and 3.6% who underwent AS, radiation (XRT), prostatectomy (RP), and brachytherapy (BT), respectively. In men with NCCN low-risk disease (n = 358), WW was performed in 15.1%, compared to AS (69.3%), XRT (4.2%), RP (6.7%), and BT (2.5%). There was wide variation in management among practices in low-risk men; WW (6%-35%), AS (44%-81%), and definitive treatment (0%-30%). Older age was associated with less likelihood of undergoing AS vs WW (odds ratio [OR] 0.88, P < .001) or treatment vs WW (OR 0.83, P < .0001). Presence of ≥cT2 disease (OR 8.55, P = .014) and greater number of positive biopsy cores (OR 1.41, P = .014) was associated with greater likelihood of treatment vs WW and Charlson comorbidity score of 1 vs 0 (OR 0.23, P = .043) was associated with less likelihood of treatment vs WW. CONCLUSION: Wide practice level variation exists in management for patients with low- and favorable-risk PCa and <10-year LE. Utilization of WW is poor, suggesting overtreatment in men who will experience little benefit. Published by Elsevier Inc.
OBJECTIVE: To determine rates of watchful waiting (WW) vs treatment in prostate cancer (PCa) and limited life expectancy (LE) and assess determinants of management. MATERIALS AND METHODS: Patients diagnosed with PCa between 2012 and 2018 with <10 years LE were identified from the Michigan Urologic Surgery Improvement Collaborative registry. Multinomial logistic regression models were used to identify factors associated with management choice among NCCN low-risk PCa patients. Data from high-volume practices were analyzed to understand practice variation. RESULTS: Total 2393 patients were included. Overall, WW was performed in 8.1% compared to 23.3%, 25%, 11.2%, and 3.6% who underwent AS, radiation (XRT), prostatectomy (RP), and brachytherapy (BT), respectively. In men with NCCN low-risk disease (n = 358), WW was performed in 15.1%, compared to AS (69.3%), XRT (4.2%), RP (6.7%), and BT (2.5%). There was wide variation in management among practices in low-risk men; WW (6%-35%), AS (44%-81%), and definitive treatment (0%-30%). Older age was associated with less likelihood of undergoing AS vs WW (odds ratio [OR] 0.88, P < .001) or treatment vs WW (OR 0.83, P < .0001). Presence of ≥cT2 disease (OR 8.55, P = .014) and greater number of positive biopsy cores (OR 1.41, P = .014) was associated with greater likelihood of treatment vs WW and Charlson comorbidity score of 1 vs 0 (OR 0.23, P = .043) was associated with less likelihood of treatment vs WW. CONCLUSION: Wide practice level variation exists in management for patients with low- and favorable-risk PCa and <10-year LE. Utilization of WW is poor, suggesting overtreatment in men who will experience little benefit. Published by Elsevier Inc.
Authors: Spencer C Hiller; Stephanie Daignault-Newton; Ivan Rakic; Susan Linsell; Bronson Conrado; S Mohammad Jafri; Ronald Rubenstein; Mazen Abdelhady; C Peter Fischer; Elena Gimenez; Richard Sarle; William W Roberts; Conrad Maitland; Rafid Yousif; Robert Elgin; Laris Galejs; Jeremy Konheim; David Leavitt; Eric Stockall; J Rene Fontera; J Stuart Wolf; John M Hollingsworth; Casey A Dauw; Khurshid R Ghani Journal: Urol Pract Date: 2022-03-03
Authors: Randy A Vince; Ralph Jiang; Daniel E Spratt; Todd M Morgan; Ji Qi; Jeffrey J Tosoian; Rebecca Takele; Felix Y Feng; Susan Linsell; Anna Johnson; Sughand Shetty; Patrick Hurley; David C Miller; Arvin George; Khurshid Ghani; Fionna Sun; Mariana Seymore; Robert T Dess; William C Jackson; Matthew Schipper Journal: Prostate Cancer Prostatic Dis Date: 2021-07-20 Impact factor: 5.554