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

Marco Moschini, Nicola Fossati, Akshay Sood, Justin K. Lee, Jesse Sammon, Maxine Sun, Dan Pucheril, Deepansh Dalela, Francesco Montorsi, Robert Jeffrey Karnes, Alberto Briganti, Quoc Trinh, Mani Menon, Firas Abdollah

Research output: Contribution to journalArticle

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Abstract

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 <10. ng/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 . <. 0.001). In multivariable analyses, clinical stage T2a (odds ratio [OR]: 1.23; . p = 0.04) and percentage of positive cores (OR: 1.10 for each 2% increase; . p . <. 0.001) were associated with a higher probability of receiving local treatment. Conversely, older age (OR: 0.89 for each 2-yr increase; . p . <. 0.001), not being married (OR: 0.64; . p . <. 0.001), and uninsured status (OR: 0.55; . p = 0.008) were associated with a lower probability of receiving active local treatment. The study is limited by the fact that SEER does not distinguish among patients undergoing observation, AS, watchful waiting, or initial hormonal therapy. 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. Despite some differences across Surveillance Epidemiology and End Results (SEER) registries, our findings showed that the majority of patients suitable for active surveillance in United States received local treatment. Several pathologic and demographic parameters were related to this decision.

Original languageEnglish (US)
JournalEuropean Urology Focus
DOIs
StateAccepted/In press - 2016

Fingerprint

Prostatic Neoplasms
Epidemiology
Population
Odds Ratio
Registries
Therapeutics
Watchful Waiting
San Francisco
Neoplasm Grading
Prostate-Specific Antigen
Insurance
Logistic Models
Regression Analysis
Observation
Demography
Databases
Biopsy

Keywords

  • Active surveillance
  • Prostate cancer
  • Racial disparities
  • SEER
  • UCSF criteria

ASJC Scopus subject areas

  • Urology

Cite this

Contemporary Management of Prostate Cancer Patients Suitable for Active Surveillance : A North American Population-based Study. / Moschini, Marco; Fossati, Nicola; Sood, Akshay; Lee, Justin K.; Sammon, Jesse; Sun, Maxine; Pucheril, Dan; Dalela, Deepansh; Montorsi, Francesco; Karnes, Robert Jeffrey; Briganti, Alberto; Trinh, Quoc; Menon, Mani; Abdollah, Firas.

In: European Urology Focus, 2016.

Research output: Contribution to journalArticle

Moschini, M, Fossati, N, Sood, A, Lee, JK, Sammon, J, Sun, M, Pucheril, D, Dalela, D, Montorsi, F, Karnes, RJ, Briganti, A, Trinh, Q, Menon, M & Abdollah, F 2016, 'Contemporary Management of Prostate Cancer Patients Suitable for Active Surveillance: A North American Population-based Study', European Urology Focus. https://doi.org/10.1016/j.euf.2016.06.001
Moschini, Marco ; Fossati, Nicola ; Sood, Akshay ; Lee, Justin K. ; Sammon, Jesse ; Sun, Maxine ; Pucheril, Dan ; Dalela, Deepansh ; Montorsi, Francesco ; Karnes, Robert Jeffrey ; Briganti, Alberto ; Trinh, Quoc ; Menon, Mani ; Abdollah, Firas. / Contemporary Management of Prostate Cancer Patients Suitable for Active Surveillance : A North American Population-based Study. In: European Urology Focus. 2016.
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abstract = "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 <10. ng/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 . <. 0.001). In multivariable analyses, clinical stage T2a (odds ratio [OR]: 1.23; . p = 0.04) and percentage of positive cores (OR: 1.10 for each 2{\%} increase; . p . <. 0.001) were associated with a higher probability of receiving local treatment. Conversely, older age (OR: 0.89 for each 2-yr increase; . p . <. 0.001), not being married (OR: 0.64; . p . <. 0.001), and uninsured status (OR: 0.55; . p = 0.008) were associated with a lower probability of receiving active local treatment. The study is limited by the fact that SEER does not distinguish among patients undergoing observation, AS, watchful waiting, or initial hormonal therapy. 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. Despite some differences across Surveillance Epidemiology and End Results (SEER) registries, our findings showed that the majority of patients suitable for active surveillance in United States received local treatment. Several pathologic and demographic parameters were related to this decision.",
keywords = "Active surveillance, Prostate cancer, Racial disparities, SEER, UCSF criteria",
author = "Marco Moschini and Nicola Fossati and Akshay Sood and Lee, {Justin K.} and Jesse Sammon and Maxine Sun and Dan Pucheril and Deepansh Dalela and Francesco Montorsi and Karnes, {Robert Jeffrey} and Alberto Briganti and Quoc Trinh and Mani Menon and Firas Abdollah",
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T1 - Contemporary Management of Prostate Cancer Patients Suitable for Active Surveillance

T2 - A North American Population-based Study

AU - Moschini, Marco

AU - Fossati, Nicola

AU - Sood, Akshay

AU - Lee, Justin K.

AU - Sammon, Jesse

AU - Sun, Maxine

AU - Pucheril, Dan

AU - Dalela, Deepansh

AU - Montorsi, Francesco

AU - Karnes, Robert Jeffrey

AU - Briganti, Alberto

AU - Trinh, Quoc

AU - Menon, Mani

AU - Abdollah, Firas

PY - 2016

Y1 - 2016

N2 - 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 <10. ng/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 . <. 0.001). In multivariable analyses, clinical stage T2a (odds ratio [OR]: 1.23; . p = 0.04) and percentage of positive cores (OR: 1.10 for each 2% increase; . p . <. 0.001) were associated with a higher probability of receiving local treatment. Conversely, older age (OR: 0.89 for each 2-yr increase; . p . <. 0.001), not being married (OR: 0.64; . p . <. 0.001), and uninsured status (OR: 0.55; . p = 0.008) were associated with a lower probability of receiving active local treatment. The study is limited by the fact that SEER does not distinguish among patients undergoing observation, AS, watchful waiting, or initial hormonal therapy. 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. Despite some differences across Surveillance Epidemiology and End Results (SEER) registries, our findings showed that the majority of patients suitable for active surveillance in United States received local treatment. Several pathologic and demographic parameters were related to this decision.

AB - 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 <10. ng/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 . <. 0.001). In multivariable analyses, clinical stage T2a (odds ratio [OR]: 1.23; . p = 0.04) and percentage of positive cores (OR: 1.10 for each 2% increase; . p . <. 0.001) were associated with a higher probability of receiving local treatment. Conversely, older age (OR: 0.89 for each 2-yr increase; . p . <. 0.001), not being married (OR: 0.64; . p . <. 0.001), and uninsured status (OR: 0.55; . p = 0.008) were associated with a lower probability of receiving active local treatment. The study is limited by the fact that SEER does not distinguish among patients undergoing observation, AS, watchful waiting, or initial hormonal therapy. 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. Despite some differences across Surveillance Epidemiology and End Results (SEER) registries, our findings showed that the majority of patients suitable for active surveillance in United States received local treatment. Several pathologic and demographic parameters were related to this decision.

KW - Active surveillance

KW - Prostate cancer

KW - Racial disparities

KW - SEER

KW - UCSF criteria

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