Who bears the greatest burden of aggressive treatment of indolent prostate cancer? - Abstract

PURPOSE: The long-term prostate cancer-specific survival for patients initially managed with active surveillance for low-risk prostate cancer ranges from 97-100%.

We characterized factors that are associated with aggressive treatment with either radical prostatectomy or radiation for indolent prostate cancer (defined as screening-detected, low-risk disease).

METHODS: The Surveillance, Epidemiology and End Results Program was used to extract a cohort of 39,803 men diagnosed with PSA-detected, low-risk prostate cancer (clinical category T1c, Gleason score< 6, and PSA< 10) from 2004 - 2010. After socioeconomic profiles were generated from county-linked education and income data, multivariable logistic regression was used to determine whether there were any factors associated with high rates of aggressive treatment.

RESULTS: The rate of aggressive treatment among all men with indolent prostate cancer was 64.3%. Greater rates of aggressive treatment were experienced by high socioeconomic status, Caucasian, and married men (P< 0.001 for all cases). The increased adjusted odds for receipt of aggressive therapy was 1.25 (95% CI 1.17-1.32; P< 0.001), 1.26 (95% CI 1.21-1.32; P< 0.001), and 1.88 (95% CI 1.80-1.97; P< 0.001) for high socioeconomic status, Caucasian, and married men, respectively, compared to low socioeconomic status, non-Caucasian, and unmarried men, respectively.

CONCLUSIONS: While high socioeconomic status, Caucasian, and married men often receive the highest quality health care and have the best outcomes for many cancers, it appears that they are most at risk for the avoidable potential harms of aggressive treatment of indolent prostate cancer. Future policy should encourage more stringent guidelines for deferred treatment and culturally and sociodemographically competent counseling of active surveillance.

Written by:
Mahal BA, Cooperberg MR, Aizer AA, Ziehr DR, Hyatt AS, Choueiri TK, Hu JC, Sweeney CJ, Beard CJ, D'Amico AV, Martin NE, Orio PF 3rd, Trinh QD, Nguyen PL.   Are you the author?
Harvard Medical School, Boston MA; Departments of Urology and Epidemiology & Public Health, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco CA; Harvard Radiation Oncology Program, Boston MA; Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston MA; Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston MA; Department of Urology, UCLA Medical Center, Los Angeles CA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston MA; Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston MA.  

Reference: Am J Med. 2015 Jan 30. pii: S0002-9343(15)00080-7.
doi: 10.1016/j.amjmed.2014.12.030


PubMed Abstract
PMID: 25644324

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