Active Surveillance for Low-Risk Prostate Cancer: Practice Variation by Geographic Location
Posted: Friday, March 19, 2021
It is well known that active surveillance of patients with prostate cancer may reduce the risk of morbidity associated with definitive treatments, such as radical prostatectomy or radiotherapy. However, the use of active surveillance and the provision of guideline-concordant care vary considerably across regions and even within individual practices. According to Matthew R. Cooperberg, MD, MPH, of the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, and colleagues the risk of overtreatment of low-risk prostate cancer may be associated with where men live and should be considered to inform future initiatives and rational prostate cancer screening policy to improve the use of active surveillance.
In this cohort study of 79,825 men with localized, low-risk prostate cancer from the Surveillance, Epidemiology, and End Results (SEER) Prostate with Watchful Waiting database, published in JAMA Network Open, the mean age was 62.8 years. In addition, 14.1% of patients (n = 11,292) were non-Hispanic Black, and 9.4% (n = 7,506) were Hispanic. Variations across SEER regions appeared to explain 17% of the observed differences in the use of active surveillance after adjustment for sociodemographic characteristics and county health resources. Other factors, such as Black race, county-level socioeconomic factors, and specialist densities, did not appear to show an association, although Hispanic ethnicity seemed to be negatively associated with the use of active surveillance. Non-Hispanic Black and Hispanic men and those with Medicaid were statistically significantly less likely to be managed with active surveillance, the authors reported.
Foremost, overall use of active surveillance was relatively low at 22.1% but increased over time, from 13.1% to 32.5% between 2010 and 2015. The researchers also observed that more men residing in counties with higher income and educational levels were more likely to be managed with active surveillance, although these observations did not persist in the hierarchical regression analysis. In addition, increasing age (51–60 years, with odds ratio = 1.33) tended to be associated with greater use of active surveillance.
Disclosure: Dr. Cooperberg has received personal fees from Astellas, Dendreon, Bayer, Janssen, Merck, and Astra Zeneca outside the submitted work. The other study authors reported no conflicts of interest.