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.

scholarly journals Active treatment in low-risk prostate cancer: a population-based study

2019 ◽  
Vol 26 (4) ◽  
Author(s):  
S. Roy ◽  
M. E. Hyndman ◽  
B. Danielson ◽  
A. Fairey ◽  
R. Lee-Ying ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Active Treatment ◽  
Population Based ◽  
Low Risk ◽  
Radiation Oncologist ◽  
Population Based Study ◽  
Younger Age ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Background  Active surveillance instead of active treatment (at) is preferred for patients with low-risk prostate cancer (LR-PCa), but practice varies widely. We conducted a population-based study to assess the proportion of patients who underwent at between January 2011 and December 2014, and to evaluate factors associated with AT.Methods  The provincial cancer registry was linked to administrative health datasets to identify patients with LR-PCa and to acquire demographic, tumour, and treatment data. The primary outcome was receipt of at during the first 12 months after diagnosis, defined as any receipt of external-beam radiotherapy, brachytherapy, radical prostatectomy, cryotherapy, or androgen deprivation. Univariate and multivariate logistic regression were used to analyze the correlation between patient and tumour factors and AT.Results  Of 1565 patients with LR-PCa, 554 (35.4%) underwent at within 12 months of diagnosis. Radical prostatectomy was the most common treatment (58%), followed by brachytherapy (29.6%). Younger age [odds ratio (or) 0.92; 95% confidence interval (ci): 0.91 to 0.94], lower score (≥3) on the Charlson comorbidity index (OR: 0.36; 95% ci: 0.19 to 0.68), T2 stage (or: 3.05; 95% ci: 2.03 to 4.58), higher prostate-specific antigen (PSA) at diagnosis (or: 1.13; 95% ci: 1.06 to 1.21), radiation oncologist consultation (or: 3.35; 95% ci: 2.55 to 4.39), and earlier diagnosis year (2012 or: 0.46; 95% ci: 0.34 to 0.63; 2013 or: 0.45; 95% ci: 0.32 to 0.63; 2014 or: 0.33; 95% ci: 0.23 to 0.47) were associated with a higher probability of AT.Conclusions  This contemporary population-based study demonstrates that approximately one third of patients with LR-PCa undergo at. Patients of younger age, with less comorbidity, a higher tumour stage, higher PSA, earlier year of diagnosis, and radiation oncologist consultation were more likely to undergo AT. Further investigation is needed to identify strategies that could minimize overtreatment.Key Words Prostate cancer, low-risk; active surveillance; active treatment; radiotherapy; brachytherapy; radical prostatectomy

scholarly journals MP48-17 DO PROGRESSION RATES ON FOLLOW UP BIOPSY OVER TIME DIFFER BETWEEN MEN WITH VERY LOW RISK AND LOW RISK PROSTATE CANCER ON ACTIVE SURVEILLANCE?

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Srinath Kotamarti* ◽  
Andrew Wood ◽  
Alyssa Yee ◽  
Daniel Rabinowitz ◽  
Allison Marziliano ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Over Time

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.

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