Evolving Trends in the Management of Low-Risk Prostate Cancer |
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| Institution: | 1. Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY;2. Department of Radiation Oncology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY;1. Struttura Semplice Dipartimentale di Oncologia Medica per la Presa in Carico Globale del Paziente Oncologico \"Don Tonino Bello,\" I.R.C.C.S. Istituto Tumori \"Giovanni Paolo II,\" Bari, Italy;2. Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy;3. Oncology Unit, Macerata Hospital, Macerata, Italy;4. Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy;1. Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany;2. Department of Urology, University Hospital of Tübingen, Germany;3. King Salman Hospital (MOH), Riyadh, Saudi-Arabia;1. Division of Urology/Urooncology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia;2. Urooncology Unit. Hospital Clinic, Universitat de Barcelona, Barcelona, Spain;1. Department of Medical Oncology, Hôpital Cochin Port Royal, AP-HP, Paris, France; Cancer Research for Personalized Medicine (CARPEM), Paris, France; Université de Paris, Paris, France;2. Department of Urology, Hôpital Cochin Port Royal, AP-HP, Paris, France; Université de Paris, Paris, France;3. Department of Immunology, Hôpital Cochin Port Royal, AP-HP, Paris, France; Université de Paris, Paris, France;1. Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany;2. Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany;1. Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY;2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY;3. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;4. SUNY Downstate Health Sciences University, Brooklyn, NY;5. Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY |
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| Abstract: | IntroductionDeferred treatment is a growing management strategy for low-risk prostate cancer. However, it is unknown whether this growth is mediated by patient factors. In this study, we sought to evaluate factors associated with deferred treatment in patients with low-risk prostate cancer and shifts in these factors after recent incorporation of active surveillance into national guidelines.Materials and MethodsWe identified 137,915 men diagnosed with low-risk prostate cancer (prostate-specific antigen <10 ng/mL, Gleason score ≤6, stage cT1-cT2a) in the National Cancer Database from 2010 to 2017. Multivariate logistic regression models were used to determine factors associated with deferred treatment. Interaction variables were added to determine whether trends in use of deferred treatment over time depend on race, income, education, and insurance status.ResultsThe use of deferred treatment among men with low-risk prostate cancer increased from 14.7% in 2010-2011 to 46.3% in 2016-2017 (P < .001). On multivariate analysis, deferred treatment was associated with older age, more contemporary year of diagnosis, black race, lower income, higher educational attainment, government insurance, being uninsured, treatment at an academic/research facility, and treatment at a facility in New England (each P < .05). Incorporation of interaction variables showed that black race, belonging to the two lowest income quartiles, government insurance, and being uninsured became less associated with deferred treatment in recent years.ConclusionsThe use of deferred treatment among men with low-risk prostate cancer increased significantly from 2010 to 2017. However, patients who were black, low-income, and not privately insured experienced smaller increases in deferred treatment. Interventions to increase uptake in these groups present opportunities to improve quality of care. |
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