Conservative Management for Low-Risk Prostate Cancer in Black Patients: A Population-Based Analysis

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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A Population-Based Study of Men With Low-Volume Low-Risk Prostate Cancer: Does African-American Race Predict for More Aggressive Disease?

Clinical Genitourinary Cancer ◽

10.1016/j.clgc.2015.02.006 ◽

2015 ◽

Vol 13 (4) ◽

pp. e259-e264 ◽

Cited By ~ 14

Author(s):

David Schreiber ◽

Arpit Chhabra ◽

Justin Rineer ◽

Jeremy Weedon ◽

David Schwartz

Keyword(s):

Prostate Cancer ◽

African American ◽

Population Based ◽

Low Risk ◽

Population Based Study ◽

Aggressive Disease ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer ◽

Low Volume ◽

African American Race

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

European Urology ◽

10.1016/j.eururo.2019.04.003 ◽

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

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

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.12 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 12-12 ◽

Cited By ~ 1

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.

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

The Journal of Urology ◽

10.1016/j.juro.2014.02.1189 ◽

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

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

Urologia Internationalis ◽

10.1159/000368417 ◽

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.

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Misclassification of Gleason grade and tumor stage in Asian-American patients with low-risk prostate cancer: A SEER-Based Analysis

10.21203/rs.3.rs-1012252/v1 ◽

2021 ◽

Author(s):

Xiao Li ◽

Zicheng Xu ◽

Wenbo Xu ◽

Feng Qi ◽

Qing Zou

Keyword(s):

Prostate Cancer ◽

Racial Differences ◽

Asian Americans ◽

Asian American ◽

Low Risk ◽

Gleason Grade ◽

Black Patients ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer ◽

Over Time

Abstract Background This study aimed to investigate the misclassification rates of Asian-American patients with low-risk prostate cancer who underwent radical prostatectomy (RP). Methods Patients diagnosed with low-risk PCa treated with RP between 2010 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were included in this study. Then, basic characteristics and pathological outcomes of enrolled patients were retrospectively extracted. We compared the rates of upgrading and/or upstaging between Asian-American patients and White/Black patients. Moreover, temporal trend analyses were performed to explore the changes in upgrading and upstaging rates in each race over time. Finally, logistic regression models were constructed to explore the role of Asian race in upgrading and upstaging and to screen out potential risk factors for predicting upgrading and upstaging in Asian-American patients. Results In patients with low-risk PCa, Asian-Americans had significantly higher rate of upgrading than Whites (51.25% vs. 45.18%, P<0.001), while no statistical difference was found in the comparison of upstaging rate (10.01 vs. 10.01, P=0.536). Moreover, Asian-Americans were more likely to upgrade to diseases with higher ISUP grade than Whites (P=0.010). The rate of upgrading increased significantly over time in White and Black patients, but not in Asian-American patients. Finally, race seemed to be an independent risk factor for predicting upgrading, while the racial differences seemed to be more pronounced between White and Black patients. Conclusion Asian-American patients had a significantly higher rate of upgrading than White patients. Moreover, Asian-American patients were more likely to upgrade to diseases with higher ISUP grade. Further risk assessment before clinical decision for low-risk PCa patients with the help of significant clinical variables is required.

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