PURPOSE: There are growing concerns regarding the overtreatment of localized prostate cancer.
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It is also relatively unknown whether there has been increased uptake of observational strategies for disease management. We assessed the temporal trend in use of observation for clinically localized prostate cancer, particularly among men with low-risk disease, who were young and healthy enough to undergo treatment.
MATERIALS AND METHODS: We conducted a retrospective cohort study using the Surveillance Epidemiology, and End Results cancer registry linked to Medicare claims (SEER-Medicare database) in 66,499 men with localized prostate cancer between 2004 and 2009. The main outcome was use of observation within one year following diagnosis. We performed multivariable analysis to develop a predictive model for use of observation adjusting for diagnosis year, age, risk and comorbidity.
RESULTS: Observation was used in 12,007 men (18%) with a slight increase over time from 17% to 20%. However, there was marked increase in the use of observation from 18% in 2004 to 29% in 2009 for men with low-risk disease. Men 66-69 years old, with low-risk disease and no comorbidities, had twice the odds of undergoing observation in 2009 versus 2004 (OR = 2.12; 95% CI = 1.73-2.59). In addition to the diagnosis year, age, risk group, comorbidity and race were independent predictors of undergoing observation (all P< .001).
CONCLUSIONS: We identified increasing use of observation for low-risk prostate cancer between 2004 and 2009, even among men young and healthy enough for treatment, suggesting growing acceptance of surveillance in this group of patients.
Ritch CR, Graves AJ, Keegan KA, Ni S, Bassett JC, Chang SS, Resnick MJ, Penson DF, Barocas DA. Are you the author?
University of Miami, Department of Urology, Miami, FL; Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, TN; San Antonio Military Medical Center, Division of Urology, San Antonio, TX, USA.
Reference: J Urol. 2014 Sep 4. pii: S0022-5347(14)04357-2.