Contemporary Management of Prostate Cancer Patients Suitable for Active Surveillance: A North American Population-based Study.
Moschini M, Fossati N, Sood A, Lee JK, Sammon J, Sun M, Pucheril D, Dalela D, Montorsi F, Karnes RJ, Briganti A, Trinh QD, Menon M, and Abdollah F. Contemporary management of prostate cancer patients suitable for active surveillance: A North American population-based study. Eur Urol Focus 2018; 4(1):68-74.
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