Contemporary Management of Prostate Cancer Patients Suitable for Active Surveillance: A North American Population-based Study.
Eur Urol Focus
; 4(1): 68-74, 2018 01.
Article
em En
| MEDLINE
| ID: mdl-28753764
ABSTRACT
BACKGROUND:
Active surveillance (AS) is increasingly recognized as a recommended treatment option for prostate cancer (PCa) patients with clinically localized, low-risk disease; however, previous studies suggested that its utilization is uncommon in the United States.OBJECTIVE:
We evaluated the nationwide utilization rate of AS in the contemporary era. DESIGN, SETTING, ANDPARTICIPANTS:
We relied on the 2010-2011 Surveillance Epidemiology and End Results (SEER) database using all 18 SEER-based registries. We identified 9049 patients that fulfilled the University of California, San Francisco AS criteria (prostate-specific antigen level <10ng/ml, clinical T stage ≤2a, Gleason score ≤6 [no pattern 4 or 5], and percentage of positive biopsy cores <33%). OUTCOME MEASUREMENTS AND STATISTICALANALYSIS:
Logistic regression analysis tested the relationship between receiving local treatment and all available predictors. RESULTS ANDLIMITATIONS:
Only 32% of AS candidates did not receive any active local treatment. This proportion varied widely among the SEER-based registries, ranging from 13% to 49% (p<0.001). In multivariable analyses, clinical stage T2a (odds ratio [OR] 1.23; p=0.04) and percentage of positive cores (OR 1.10 for each 2% increase; p<0.001) were associated with a higher probability of receiving local treatment. Conversely, older age (OR 0.89 for each 2-yr increase; p<0.001), not being married (OR 0.64; p<0.001), and uninsured status (OR 0.55; p=0.008) were associated with a lower probability of receiving active local treatment. The study is limited by the fact that SEER does not distinguish among patients undergoing observation, AS, watchful waiting, or initial hormonal therapy.CONCLUSIONS:
In the United States, a considerable proportion of patients suitable for AS receive local treatment for PCa. Proportions differ significantly among SEER registries. PATIENTSUMMARY:
Having more extensive and palpable disease, having medical insurance, being married, and being younger are associated with an increased probability of receiving local treatment for low-risk prostate cancer.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Próstata
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Programa de SEER
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Conduta Expectante
Tipo de estudo:
Prognostic_studies
/
Screening_studies
Limite:
Aged
/
Humans
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Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Eur Urol Focus
Ano de publicação:
2018
Tipo de documento:
Article