Trends in Conservative Management for Low-risk Prostate Cancer in a Population-based Cohort of Australian Men Diagnosed Between 2009 and 2016

2019 ◽  
Author(s):  
Wee Loon Ong ◽  
Sue M. Evans ◽  
Melanie Evans ◽  
Mark Tacey ◽  
Lachlan Dodds ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Conservative Management ◽  
Population Based ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Management of low-risk prostate cancer in a population-based cohort of Australian men between 2008 and 2016.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 13-13
Author(s):  
Wee Loon Ong ◽  
Farshad Foroudi ◽  
Susan M. Evans ◽  
Jeremy Laurence Millar
Keyword(s):  
Prostate Cancer ◽  
Active Treatment ◽  
Conservative Management ◽  
Local Treatment ◽  
Local Therapy ◽  
Population Based ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Over Time

13 Background: The aim of this study is to evaluate the practice pattern of management of NCCN low-risk prostate cancer (LRPC) in a population-based cohort of Australian men. Methods: This is prospective cohort of men captured in Prostate Cancer Outcomes Registry Victoria (PCOR-Vic), who were diagnosed with LRPC between Aug 2008 and Dec 2016. Conservative management was defined as no active treatment (surgery, radiotherapy, or other local therapy) within 12-month of LRPC diagnosis. Chi-squared test for trend was used to evaluate change in practice over time. Multivariate logistics regressions were used to patient-, tumour- and institutional factors influencing the likelihood of conservative management for LRPC. Results: A total of 3238 men with LRPC were identified in the PCOR-Vic database. The median age was 62.6 (range:37-94). The median PSA level was 5.1ng/mL (range: 0.01-9.96). Overall, 1934 (60%) had conservative management, of which 1668 (86%) were documented as being on active surveillance. Of the 1304 (40%) men who active treatment within 12-month of diagnosis, 977 (30%) had surgeries, 289 (9%) had radiotherapy, and 38 (1%) had other local treatment. Overall, there is increasing trend in conservative management for LRPC from 52% in 2009 to 73% in 2016 (P<0.001). In multivariate analyses, age, PSA, clinical stage, institutions and year of diagnosis were all independently associated with conservative management. Men diagnosed in private and regional centres were 26% (95%CI=0.63-0.88, P=0.001) and 40% (95% CI=0.51-0.72, P<0.001) less likely to have conservative management for LRPC. Conclusions: This is the largest Australian series on management of LRPC to date. We observe increasing use of conservative management for LRPC over time, however, there is large institutional variations in care with men diagnosed in private and regional centres more likely to have active local management for LRPC.

Conservative management of low-risk prostate cancer among young versus older men in the United States: Trends and outcomes from a novel national database.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 12-12 ◽  
Author(s):  
Amandeep R Mahal ◽  
Santino Butler ◽  
Idalid Ivy Franco ◽  
Luke Roy George Pike ◽  
Shuang Zhao ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Conservative Management ◽  
The United States ◽  
Low Risk ◽  
Definitive Treatment ◽  
Short Term ◽  
Initial Management ◽  
Positive Biopsy ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

12 Background: The optimal management for men age ≤55 with low-risk prostate cancer (PCa) is debated given quality of life implications with definitive treatment versus potential missed opportunity for cure with conservative management. We sought to define rates of conservative management for low-risk PCa and associated short-term outcomes in young versus older men in the United States (U.S.). Methods: The Surveillance, Epidemiology, and End Results (SEER) Prostate with Active Surveillance/Watchful Waiting (AS/WW) Database identified 50,302 men diagnosed with low-risk PCa from 2010-2015. AS/WW rates in the U.S. were stratified by age (≤55 versus ≥56). Prostate cancer-specific mortality (PCSM)and overall mortality were defined by initial management type (AS/WW versus definitive treatment [referent]) and age. This non-public data was released by the SEER custom data group. Results: AS/WW utilization increased from 8.61% in 2010 to 34.56% in 2015 among men age ≤55 (Ptrend< 0.001) and from 15.99% to 43.81% among men age ≥56 (Ptrend< 0.001). Among patients with ≤2 positive biopsy cores, AS/WW rates increased from 12.90% to 48.78% for men age ≤55 and from 21.85% to 58.01% for men age ≥56. Among patients with ≥3 positive biopsy cores, AS/WW rates increased from 3.89% to 22.45% for men age ≤55 and from 10.05% to 28.49% for men age ≥56 (all Ptrend< 0.001). Five-year PCSM rates were below 0.30% across age and initial management type subgroups. Conclusions: AS/WW rates quadrupled for patients age ≤55 from 2010-2015, with favorable short-term outcomes. These findings demonstrate the short-term safety and increasing acceptance of AS/WW for both younger and older patients. However, there are still higher absolute rates of AS/WW in older patients (P < 0.001), suggesting some national ambivalence toward AS/WW in younger patients.

MP42-12 NATIONWIDE POPULATION-BASED STUDY OF MIGRATION WITHIN THE LOW-RISK PROSTATE CANCER CATEGORY

2014 ◽  
Vol 191 (4S) ◽  
Author(s):  
Erin Ohmann ◽  
Stacy Loeb ◽  
David Robinson ◽  
Anna Bill-Axelson ◽  
Anders Berglund ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Population Based ◽  
Low Risk ◽  
Population Based Study ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Differences among Men on Active Surveillance for Very Low-Risk Prostate Cancer Detected Through Population-Based versus Opportunistic Prostate-Specific Antigen-Screening

2015 ◽  
Vol 94 (3) ◽  
pp. 330-336
Author(s):  
Marco Randazzo ◽  
Josef Beatrice ◽  
Andreas Huber ◽  
Rainer Grobholz ◽  
Lukas Manka ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Cox Regression ◽  
Screening Program ◽  
Specific Antigen ◽  
Population Based ◽  
Low Risk ◽  
Cox Regression Analysis ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Introduction: Very low-risk prostate cancer (PCa) is being increasingly managed by active surveillance (AS). Our aim was to assess the influence of the origin of diagnosis on PCa characteristics and treatment rates among men with very low-risk PCa in our prospective AS cohort. Methods: Overall, 191 men with very low-risk PCa fulfilling Epstein-criteria underwent protocol-based AS. These men originated either from the prospective population-based screening program (P-AS) or were diagnosed by opportunistic screening (O-AS). Results: Overall, n = 86 (45.0%) originated from the P-AS group, whereas n = 105 (55.0%) from the O-AS group. On univariate Cox regression analysis, age (HR 0.96, 95% CI 0.92-1.00; p = 0.05), origin of diagnosis (HR 0.72, 95% CI 0.41-1.28; p = 0.001), number of positive cores (HR 2.15, 95% CI 1.18-3.90; p = 0.01) and maximum core involvement (HR 1.03, 95% CI 0.99-1.05; p = 0.05) were predictors for treatment necessity. On multivariate analysis, age (HR 0.95, 95% CI 0.89-0.99; p = 0.05), number of positive cores (HR 2.07, 95% CI 1.10-3.88; p = 0.02), maximum core involvement (HR 1.03, 95% CI 1.00-1.06; p = 0.04) but not origin of diagnosis were independent predictors for treatment necessity. Four men developed biochemical recurrence (all from O-AS group [p = 0.05]). Conclusion: The origin of PCa diagnosis in men undergoing AS had no influence on disease progression and treatment necessity.

scholarly journals Conservative management of low‐risk prostate cancer among young versus older men in the United States: Trends and outcomes from a novel national database

Cancer ◽  
2019 ◽  
Vol 125 (19) ◽  
pp. 3338-3346 ◽  
Author(s):  
Amandeep R. Mahal ◽  
Santino Butler ◽  
Idalid Franco ◽  
Vinayak Muralidhar ◽  
Dalia Larios ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Conservative Management ◽  
Older Men ◽  
The United States ◽  
Low Risk ◽  
National Database ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Racial differences in long-term prostate cancer specific mortality following conservative management for low-risk prostate cancer: A population-based study.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 121-121
Author(s):  
Grace L. Lu-Yao ◽  
Nikita Nikita ◽  
Scott W Keith ◽  
Joshua Banks ◽  
Nathan Handley ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Racial Differences ◽  
Population Based ◽  
Low Risk ◽  
Population Based Study ◽  
Specific Mortality ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Cancer Specific Mortality

121 Background: It is uncertain whether the same criteria for active surveillance can be applied universally across races. This population-based study was undertaken to quantify racial differences in long-term risk of prostate cancer-specific mortality (PCSM) among patients with low-risk prostate cancer (PCa) receiving conservative management. Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database to identify patients who had low-risk PCa (T1-T2a & Gleason 6 & PSA ≤ 10 ng/mL & N0 & M0) diagnosed in 2004 – 2015 and did not receive radical prostatectomy or radiation therapy within one year of diagnosis. Kaplan-Meier analysis was used to calculate PCSM. The Clopper-Pearson method was used to calculate associated 95% confidence intervals. Hazard ratio of PCSM among those with a high PSA (PSA 4-10) compared to those with a low PSA (PSA < 4) was calculated using Cox proportional hazards models adjusted for covariates (including age, race, marital status, insurance status, U.S. region, year of diagnosis, and AJCC clinical tumor stage). Results: Among 33,740 patients with low-risk PCa, long-term PCSM varied with race and PSA levels at diagnosis. For instance, 10-year PCSM was 2.62% (95% CI: 1.15%-5.05%) among African Americans with PSA 4-10 and 0.98% (95% CI:0.16%-3.12%) among Caucasian patients with PSA < 4. There was no significant statistical interaction between race and PSA level on PCSM (p = 0.81). After adjusting for potential confounders, men with PSA 4-10 experienced 2-fold higher PCSM relative to those with PSA < 4 (HR = 1.96, p = 0.011) and African Americans men experienced a 43% higher PCSM compared to Caucasians (HR = 1.43, p = 0.03). Conclusions: Among men diagnosed with low-risk PCa, long-term PCSM varies by race and PSA at diagnosis. More refined risk stratification may improve PCa management among low-risk PCa patients. [Table: see text]

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