PURPOSE: Factors affecting the adoption of non-curative initial management (NCIM) in the United States for low-risk prostate cancer (PCa) on a population-based level are unknown. Our objectives were to measure temporal trends in the proportion of low- and intermediate-risk PCa patients electing NCIM in the US and analyze the association of factors affecting management choice.
MATERIALS AND METHODS: We identified 465,591 and 237,257 men diagnosed with low- or intermediate-risk PCa using the National Cancer Database (NCDB) and Surveillance, Epidemiology, and End Results (SEER) (2004-2010), respectively. We measured the proportion of men electing NCIM and used multivariate logistic regression analyses to evaluate factors affecting management choice.
RESULTS: Over the study period, among low-risk patients, NCIM increased in SEER from 21% to 32% and in the NCDB from 13% to 20% (both p< 0.001). This increase was not reflected in our overall study population (SEER: 20% to 22% NCDB: 11% to 13%) as the proportion of patients with Gleason ≤ 6 decreased over time (SEER: 61% to 49% NCDB: 61% to 45%). From 2004 to 2010, older age, lower PSA, earlier clinical stage, increased comorbidity index, and not being married were associated with a higher likelihood of NCIM (all p< 0.05).
CONCLUSIONS: Two, independently-managed population-based datasets confirm a temporal increase in NCIM among low-risk patients that did not translate into greater use overall among low- and intermediate-risk patients combined. These contrasting results are likely due to grade migration resulting in fewer men being classified as low-risk based on Gleason score.
Weiner AB, Patel SG, Etzioni R, Eggener SE. Are you the author?
Pritzker School of Medicine Fellow, The University of Chicago Medical Center, Chicago, Illinois; Urologic Oncology Fellow, The University of Chicago Medical Center, Chicago, Illinois; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Associate Professor of Surgery Urologic Oncology Fellow, The University of Chicago Medical Center, Chicago, Illinois.
Reference: J Urol. 2014 Aug 5. pii: S0022-5347(14)04151-2.