Contemporary Management of Prostate Cancer Patients Suitable for Active Surveillance: A North American Population-based Study.

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Eur Urol Focus


BACKGROUND: Active surveillance (AS) is increasingly recognized as a recommended treatment option for prostate cancer (PCa) patients with clinically localized, low-risk disease; however, previous studies suggested that its utilization is uncommon in the United States.

OBJECTIVE: We evaluated the nationwide utilization rate of AS in the contemporary era.

DESIGN, SETTING, AND PARTICIPANTS: We relied on the 2010-2011 Surveillance Epidemiology and End Results (SEER) database using all 18 SEER-based registries. We identified 9049 patients that fulfilled the University of California, San Francisco AS criteria (prostate-specific antigen level <10ng/ml, clinical T stage ≤2a, Gleason score ≤6 [no pattern 4 or 5], and percentage of positive biopsy cores <33%).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Logistic regression analysis tested the relationship between receiving local treatment and all available predictors.

RESULTS AND LIMITATIONS: Only 32% of AS candidates did not receive any active local treatment. This proportion varied widely among the SEER-based registries, ranging from 13% to 49% (p

CONCLUSIONS: In the United States, a considerable proportion of patients suitable for AS receive local treatment for PCa. Proportions differ significantly among SEER registries.

PATIENT SUMMARY: Having more extensive and palpable disease, having medical insurance, being married, and being younger are associated with an increased probability of receiving local treatment for low-risk prostate cancer.

Medical Subject Headings

Aged; Brachytherapy; Humans; Male; Middle Aged; Neoplasm Grading; Neoplasm Staging; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; SEER Program; United States; Watchful Waiting

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