SUO 2017: Impact Of USPSTF Recommendation On Rates Of Non-definitive Management In Low Risk Prostate Cancer Utilizing The National Cancer Database

Washington, DC (UroToday.com) Introduction: Since the 2011 U.S. Preventative Services Task Force (USPSTF) recommendation against prostate cancer (PCa) screening, there have been various modifications observed in the practice of urology. This caused the authors to hypothesize that low risk PCa has been managed more conservatively, secondary to the USPSTF recommendation and therefore they sought to evaluate the rates of non-definitive management (NDM) during this era.

Methods: The authors performed a retrospective cohort study of 105,295 patients in the National Cancer Database (NCDB) diagnosed with NCCN low risk PCa from 2010-2013. The primary endpoint was to identify rates of NDM {active surveillance (AS) + watchful waiting (WW)} before and after the USPSTF recommendation against PSA screening in 2011. Multivariable logistic regression analysis was performed to evaluate patient specific factors contributing to this form of management. Covariates included in the model included age, race, clinical stage, facility volume, facility type, insurance, Charlson comorbidity index, PSA, year of diagnosis, geographic location, and neighborhood income.

Results: Of the 105,295 patients found to harbor low risk disease, 15,423 (15%) elected NDM versus 89,872 (85%) who elected active treatment. Of these 15,423 patients, 75% were on AS and 25% on WW. Median age of patients electing NDM versus treatment was 65 and 62 years old, respectively. The rate of NDM in the years prior to the USPSTF recommendation was 10.1% and 12.9% in 2010 and 2011, respectively p<0.001. NDM increased in the years following the
USPSTF recommendation of 2011 with the rate of NDM of 17.04% in 2012 (OR 1.92, p<0.001), and increasing to 21.6% in 2013 (OR 2.56, p<0.001). At the current rate of change of 3.85% per year, if no changes are witnessed, NDM utilization would reach 50% by the year 2021.

Conclusion: Since the USPSTF recommendation, NDM utilization has significantly increased in patients with low risk PCa. This data highlights the continued underutilization of surveillance in this patient population.

Presented by: John Burns, Virginia Mason Medical Center, Seattle, WA, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC