Abstract
Introduction
Deferred treatment is a growing management strategy for low-risk prostate cancer.
However, it is unknown whether this growth is mediated by patient factors. In this
study, we sought to evaluate factors associated with deferred treatment in patients
with low-risk prostate cancer and shifts in these factors after recent incorporation
of active surveillance into national guidelines.
Materials and Methods
We identified 137,915 men diagnosed with low-risk prostate cancer (prostate-specific
antigen <10 ng/mL, Gleason score ≤6, stage cT1-cT2a) in the National Cancer Database
from 2010 to 2017. Multivariate logistic regression models were used to determine
factors associated with deferred treatment. Interaction variables were added to determine
whether trends in use of deferred treatment over time depend on race, income, education,
and insurance status.
Results
The use of deferred treatment among men with low-risk prostate cancer increased from
14.7% in 2010-2011 to 46.3% in 2016-2017 (P < .001). On multivariate analysis, deferred treatment was associated with older age,
more contemporary year of diagnosis, black race, lower income, higher educational
attainment, government insurance, being uninsured, treatment at an academic/research
facility, and treatment at a facility in New England (each P < .05). Incorporation of interaction variables showed that black race, belonging
to the two lowest income quartiles, government insurance, and being uninsured became
less associated with deferred treatment in recent years.
Conclusions
The use of deferred treatment among men with low-risk prostate cancer increased significantly
from 2010 to 2017. However, patients who were black, low-income, and not privately
insured experienced smaller increases in deferred treatment. Interventions to increase
uptake in these groups present opportunities to improve quality of care.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Genitourinary CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
National Comprehensive Cancer Network. Prostate Cancer (Version 1.2022). Published online September 10, 2021. Accessed November 27, 2021. Available at: https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf
- Long-term follow-up of a large active surveillance cohort of patients with prostate cancer.JCO. 2015; 33: 272-277https://doi.org/10.1200/JCO.2014.55.1192
- 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer.N Engl J Med. 2016; 375: 1415-1424https://doi.org/10.1056/NEJMoa1606220
- Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer. Cochrane Urology Group, ed.Cochrane Database Syst Rev. 2017; (Published online September 12)https://doi.org/10.1002/14651858.CD009625.pub2
- NCCN clinical practice guidelines in oncology: prostate cancer.J Natl Compr Canc Netw. 2010; 8: 162-200https://doi.org/10.6004/jnccn.2010.0012
- National trends in the management of low and intermediate risk prostate cancer in the United States.J Urol. 2015; 193: 95-102https://doi.org/10.1016/j.juro.2014.07.111
- Contemporary management of prostate cancer patients suitable for active surveillance: A North American population-based study.Eur Urol Focus. 2018; 4: 68-74https://doi.org/10.1016/j.euf.2016.06.001
- Increasing rate of noninterventional treatment management in localized prostate cancer candidates for active surveillance: A North American population-based study.Clin Genitourin Cancer. 2019; 17 (e4): 72-78https://doi.org/10.1016/j.clgc.2018.09.011
- Contemporary use of initial active surveillance among men in michigan with low-risk prostate cancer.Eur Urol. 2015; 67: 44-50https://doi.org/10.1016/j.eururo.2014.08.024
- Active surveillance for men with intermediate risk prostate cancer.J Urol. 2021; 205: 115-121https://doi.org/10.1097/JU.0000000000001241
- Increasing use of observation among men at low risk for prostate cancer mortality.J Urol. 2015; 193: 801-806https://doi.org/10.1016/j.juro.2014.08.102
- Five-year nationwide follow-up study of active surveillance for prostate cancer.Eur Urol. 2015; 67: 233-238https://doi.org/10.1016/j.eururo.2014.06.010
- Active surveillance for low-risk prostate cancer in Black Patients.N Engl J Med. 2019; 380 (Published online): 2070-2072https://doi.org/10.1056/NEJMc1900333
- Population based study of use and determinants of active surveillance and watchful waiting for low and intermediate risk prostate cancer.J Urol. 2013; 190: 1742-1749https://doi.org/10.1016/j.juro.2013.05.054
- Prevalence, predictors, and implications for appropriate use of active surveillance management among black men diagnosed with low-risk prostate cancer.Am J Clin Oncol. 2019; 42: 507-511https://doi.org/10.1097/COC.0000000000000547
- The National Cancer Data Base: a clinical surveillance and quality improvement tool.J Surg Oncol. 2004; 85: 1-3https://doi.org/10.1002/jso.10320
- Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology.J Natl Compr Canc Netw. 2019; 17: 479-505https://doi.org/10.6004/jnccn.2019.0023
- Active surveillance for Black Men with low-risk prostate cancer in the United States.N Engl J Med. 2019; 381: 2581-2582https://doi.org/10.1056/NEJMc1912868
- The new surveillance, epidemiology, and end results prostate with watchful waiting database: opportunities and limitations.Eur Urol. 2020; 78: 335-344https://doi.org/10.1016/j.eururo.2020.01.009
- Strengths and limitations of large databases in lung cancer radiation oncology research.Transl Lung Cancer Res. 2019; 8: S172-S183https://doi.org/10.21037/tlcr.2019.05.06
- United States trends in active surveillance or watchful waiting across patient socioeconomic status from 2010 to 2015.Prostate Cancer Prostatic Dis. 2020; 23: 179-183https://doi.org/10.1038/s41391-019-0175-9
- Socioeconomic status and breast cancer incidence in California for dierent race/ethnic groups.Cancer Causes Control. 2001; 12: 703-711
- National economic conditions and patient insurance status predict prostate cancer diagnosis rates and management decisions.J Urol. 2016; 195: 1383-1389https://doi.org/10.1016/j.juro.2015.12.071
- Use of conservative management for low-risk prostate cancer in the veterans affairs integrated health care system from 2005-2015.JAMA. 2018; 319: 2231https://doi.org/10.1001/jama.2018.5616
- Quality of life outcomes after primary treatment for clinically localised prostate cancer: a systematic review.Eur Urol. 2017; 72: 869-885https://doi.org/10.1016/j.eururo.2017.06.035
- Comparison of commission on cancer-approved and -nonapproved hospitals in the United States: implications for studies that use the National Cancer Data Base.J Clin Oncol. 2009; 27: 4177-4181https://doi.org/10.1200/JCO.2008.21.7018
- Using the National Cancer Database for outcomes research: a review.JAMA Oncol. 2017; 3: 1722https://doi.org/10.1001/jamaoncol.2016.6905
- Comparison of cases captured in the National Cancer Data Base with those in population-based central cancer registries.Ann Surg Oncol. 2013; 20: 1759-1765https://doi.org/10.1245/s10434-013-2901-1
- African American Men with very low–risk prostate cancer exhibit adverse oncologic outcomes after radical prostatectomy: should active surveillance still be an option for them?.JCO. 2013; 31: 2991-2997https://doi.org/10.1200/JCO.2012.47.0302
Article info
Publication history
Published online: May 10, 2022
Accepted:
May 8,
2022
Received in revised form:
May 6,
2022
Received:
February 14,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.