AUA 2017: The Uncoupling of Diagnosis and Immediate Treatment in Very Low and Low Risk Prostate Cancer: A National Perspective
For this study, the authors used the National Cancer Database from 2010-2013, of which 46,290 men were very low risk and 60,122 men had low risk prostate cancer based on NCCN criteria. The primary outcome of this study was treatment within 1-year of diagnosis, specifically radical prostatectomy (RP), radiotherapy (RT), or androgen deprivation therapy (ADT). Men managed with active surveillance (AS), watchful waiting (WW), or no treatment (NoTx) were also analyzed. Among the combined low and very low risk cohort, the median age was 62, and a surprisingly high 74.8% of men received primary treatment within 1 year of diagnosis. In men >65 years of age, 28.9% had RP, 35.9% received RT, and 19.2% had AS/WW/NoTx. Among men >75 years of age, 5.3% received RP, 39.9% received RT, and 25.4% had AS/WW/NoTx. Variables associated with lower odds of treatment included age >65 (OR 0.55, 95%CI 0.53-0.57), being treated at an academic medical center (OR 0.68, 95%CI 0.66-0.71), and increasing year of diagnosis after 2010. Importantly, primary treatment rates declined over time while management with AS/WW/NoTx increased. The strength of the study is the large cohort to allow extensive analysis of predictors of receiving treatment. A limitation of the study is the relatively short time frame over which patients were evaluated.
As the authors have reported herein, there are still a large number of patients in the US receiving primary treatment within 1 year of diagnosis for low or very low risk prostate cancer. Particularly among older men, in most/all instances this represents a gross overtreatment of disease that may never become life threatening. When comparing AS rates to other jurisdictions (ie. Canada and Europe), embracing AS in the US has room for improvement.
Presented By: Richard Matulewicz, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
Co-Authors: John Oliver DeLancey, Anuj Desai, Adam Weiner, Edward Schaeffer
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA