ASCO GU 2018: Why are Low-risk Prostate Cancers (Pca) Treated Aggressively? A Population-based Cohort Analysis

San Francisco, CA ( Dr. Ramsankar Basak presented on the assessment he and his colleagues performed in which they utilized a population-level analysis to assess why men with low-risk prostate cancer are treated aggressively.  As per the AUA guidelines [1], active surveillance is the best option for men with very low-risk prostate cancer and preferred option for all low-risk patients. However, despite improved adoption, active surveillance continues to be underused. The objective of this study was to examine decision-making factors among patients with low risk prostate cancer.

For this study, the authors utilized rapid case ascertainment of the North Carolina Cancer Registry, identifying 1,456 patients enrolled from 2011-2013. NCCN risk group and treatments received (or active surveillance) were determined using medical records and registry data. Using a phone survey, patients were asked about their perceived cancer aggressiveness, most important decision-making factor (i.e., cure, quality of life, family burden, cost, daily activity), and desire to be involved in the decision process. Among the 585 low-risk patients, 38% pursued active surveillance. On multivariable analysis, patient desire to pursue aggressive treatment (very aggressive: OR 23.33, p <0.001) and perceived cancer aggressiveness (OR 4.66, p<0.001) were significantly associated with aggressive treatment instead of active surveillance. Furthermore, patients indicating that the primary decision was themselves (rather than their physician) were more likely to receive aggressive treatment (OR 1.76, p=0.23). In the subgroup of 346 very low-risk patients, 48% received active surveillance, and patient desire for aggressive treatment (OR 22.53, p<0.001) and perceived aggressiveness (OR 4.94, p<0.001) remained significant factors.

The authors concluded that patient desire for aggressive treatment and misperception of cancer aggressiveness were dominant factors for low-risk patients receiving aggressive treatment instead of active surveillance. Certainly, ascertaining patient goals for treatment and more accurate information about low-risk PCa may improve physician counseling/patient education and reduce inappropriate underutilization of active surveillance.

Speaker: Ramsankar Basak, University of North Carolina at Chapel Hill, Chapel Hill, NC

Co-Authors: Deborah S Usinger, Paul Alphonso Godley, Ronald C. Chen

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter:@zklaassen_md at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA

1. Carter HB, Albertsen PC, Barry MJ et al: Early detection of prostate cancer: AUA Guideline. J Urol 2013; 190: 419.

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