Sociodemographic and clinical predictors of switching to active treatment among a large ethnically diverse cohort of men with low-risk prostate cancer on observational management.

To determine the clinical and sociodemographic predictors of beginning an active treatment among an ethnically diverse population of men with low-risk prostate cancer initially on observational management.

We retrospectively studied men diagnosed with low-risk prostate cancer between 2004 and 2012 at Kaiser Permanente Northern California, who did not receive any treatment within the first year of diagnosis and had at least two years of follow-up. We used Cox proportional hazards regression models to determine factors associated with time from diagnosis until active treatment.

We identified 2,228 eligible men who were initially on observation, and 27% began an active treatment during follow-up (median 2.9 years). Non-Hispanic Black men were marginally more likely to begin an active treatment (hazard ratio [HR] 1.3, 95% CI 1.0-1.7) than non-Hispanic White men, independent of baseline and follow-up clinical measures. Among men who remained on observation, non-Hispanic Black men were re-biopsied within 24 months of diagnosis at slightly lower rates than non-Hispanic White men (HR 0.70, 95% CI 0.6-1.0). Gleason grade progression (HR 3.3, 95% CI 2.7-4.1) and a PSA doubling time < 48 months (HR 2.9, 95% CI 2.3-3. 7) were associated with initiation of active treatment, independent of race.

Sociodemographic factors, such as ethnicity and education, may independently influence a patient's decision to pursue active treatment and their utilization of serial biopsies during active surveillance. These factors are important in further studies of prostate cancer treatment decision making.

The Journal of urology. 2016 Apr 14 [Epub ahead of print]

Scott P Kelly, Stephen K Van Den Eeden, Richard M Hoffman, David S Aaronson, Tania Lobo, George Luta, Amethyst D Leimpter, Jun Shan, Arnold L Potosky, Kathryn L Taylor

Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC. Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Urology, Kaiser Oakland Medical Center, Northern California, Oakland, CA., Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA., Department of Urology, Kaiser Oakland Medical Center, Northern California, Oakland, CA., Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC., Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC., Division of Research, Kaiser Permanente Northern California, Oakland, CA., Division of Research, Kaiser Permanente Northern California, Oakland, CA., Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC., Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC.

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