Overactive Surveillance: Is “Conservative” Management for Low-risk Prostate Cancer Too Aggressive?

2019 ◽  
Vol 76 (4) ◽  
pp. 467-468
Author(s):  
Stacy Loeb
Keyword(s):  
Prostate Cancer ◽  
Conservative Management ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

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.

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

Active surveillance and watchful waiting for low-risk prostate cancer in black patients: A population-based analysis.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 10-10
Author(s):  
Santino Butler ◽  
Vinayak Muralidhar ◽  
Anthony Victor D'Amico ◽  
Paul L. Nguyen ◽  
Timothy Rebbeck ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Black Men ◽  
Active Surveillance ◽  
Conservative Management ◽  
Watchful Waiting ◽  
Low Risk ◽  
Positive Biopsy ◽  
Definitive Therapy ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

10 Background: Evidence from clinical trials supports conservative management as an acceptable alternative to definitive therapy for low-risk prostate cancer (LRPC). The optimal approach for Black men, however, remains unclear given trial underrepresentation and concern about racial differences in disease aggressiveness. We therefore sought to determine U.S. conservative management utilization rates for Black men with LRPC. Methods: The Surveillance, Epidemiology, and End Results (SEER) Program Prostate with Active Surveillance/Watchful Waiting (AS/WW) Database queried 50,302 LRPC patients (N = 5218 Black), diagnosed from 2010-2015. Trends in AS/WW utilization over time were determined, stratified by race (Black versus non-Black) and number of positive biopsy cores (≤2 versus ≥3). Results: From 2010 to 2015, AS/WW utilization increased from 12.6% to 36.4% among Black men (Ptrend< 0.001) and from 14.8% to 43.3% among non-Black men (Ptrend< 0.001). AS/WW rates reached 52.0% and 57.3% by 2015 for Black (Ptrend< 0.001) and non-Black (Ptrend< 0.001) men with ≤2 positive biopsy cores, respectively. Rates continually increased for all subgroups except Black men with ≥3 positive biopsy cores, where rates plateaued at 22.9% by 2013. Conclusions: In this report from the largest U.S. population of Black LRPC patients with quality assured AS/WW data, AS/WW rates have nearly tripled for Black men from 2010-2015, suggesting AS/WW is viewed as a safe management option in all races.

scholarly journals Exploring Variation in the Use of Conservative Management for Low-risk Prostate Cancer in the Veterans Affairs Healthcare System

2020 ◽  
Vol 77 (6) ◽  
pp. 683-686 ◽  
Author(s):  
Stacy Loeb ◽  
Nataliya K. Byrne ◽  
Binhuan Wang ◽  
Danil V. Makarov ◽  
Daniel Becker ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Healthcare System ◽  
Conservative Management ◽  
Veterans Affairs ◽  
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.

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