Increasing Rate of Noninterventional Treatment Management in Localized Prostate Cancer Candidates for Active Surveillance: A North American Population-Based Study |
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Authors: | Marco Bandini Sebastiano Nazzani Michele Marchioni Felix Preisser Zhe Tian Marco Moschini Firas Abdollah Nazareno Suardi Markus Graefen Francesco Montorsi Shahrokh F Shariat Fred Saad Alberto Briganti Pierre I Karakiewicz |
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Institution: | 1. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy;2. Centre de recherche du Centre Hospitalier de l''Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada;3. Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy;4. Department of Urology, SS Annunziata Hospital, “G. D''Annunzio” University of Chieti, Chieti, Italy;5. Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;6. Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Hospital, Henry Ford Health System, Detroit, MI;7. Department of Urology, Medical University of Vienna, Vienna, Austria |
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Abstract: | BackgroundThe rate of noninterventional treatment (NIT) in prostate cancer (PCa) active surveillance (AS) candidates is on the rise. However, contemporary data are unavailable. We described community-based NIT rates within 16 Surveillance Epidemiology and End Results (SEER) registries between 2010 and 2014.Patients and MethodsWe identified 23,360 PCa patients who fulfilled the University of California San Francisco AS criteria (prostate-specific antigen PSA] < 10 ng/mL, clinical T stage ≤ T2a, Gleason score ≤ 6, and positive cores < 33%). Annual NIT rates as well as patient distribution according to PSA, age, number of positive cores, and clinical T stage were studied. Multivariable logistic regression analysis tested NIT predictors.ResultsBetween 2010 and 2014, the NIT rate increased from 30.2% to 57.5% (P = .004). Within 16 SEER registries, NIT rates ranged from 25.9% to 62%. NIT rate increased uniformly within all examined registries. Of patient and tumor characteristics (PSA > 4 ng/mL, cT2a and > 1 positive core) only the proportion of NIT patients aged < 65 years increased over time from 47.3% to 53.2% (P = .03). By multivariable logistic regression analysis predicting NIT rate, older age (odd ratio OR] = 1.05), more contemporary year of diagnosis (OR = 1.41), and being unmarried (OR = 1.45) and uninsured (OR = 2.41) were independent predictors.ConclusionThe NIT rate has markedly increased across all examined SEER registries. Nonetheless, important differences distinguish those who received high-end NIT from low-end NIT. PCa characteristics of NIT patients remained unchanged over time. However, in addition to geographical differences in NIT rates, patient characteristics such as age, marital status, and insurance status represent potential NIT access barriers. |
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Keywords: | Active surveillance Local treatment Non-interventional treatment Prostate cancer SEER registries |
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