Trends in Use of Expectant Management of Low-Risk Prostate Cancer

SAN FRANCISCO—In older patients and in patients with multiple comorbidities, low-risk prostate cancer is increasingly being managed with expectant management (EM), including active surveillance and watchful waiting. One factor driving this increase in use of EM is the desire to minimize overtreatment of prostate cancer.

4 - Matthew J. Maurice, MDMatthew J. Maurice, MD, and colleagues recently conducted a study to evaluate current trends in utilization of EM and to identify factors associated with the increase in the use of EM. They reported study results during a poster session at the 2014 Genitourinary Cancers Symposium. The poster was titled A Population-Based Study of Expectant Management Utilization and Its Predictors for Low-Risk Prostate Cancer.

The researchers utilized data from the National Cancer Database, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, to identify men with low-risk prostate cancer diagnosed between 2004 and 2011 (n=285,562).

Low-risk prostate cancer was defined as Gleason score of 6 or lower, no Gleason pattern 4 or 5, CT1-cT2a. Men within that cohort were classified as having undergone EM (defined as no first-course surgery, radiation, hormone therapy, or chemotherapy) or active treatment. To determine predictors of EM selection, patient and provide variables were analyzed using univariate and multivariate logistic regression models.

Of the total cohort, 11.9% (n=34,132) men received EM. With time, there was a significant and steady rise in EM usage beginning in 2008 (range 9.8-18.6%). Compared with 2004, patients diagnosed in 2011 were 2.5 times more likely to receiving EM (OR = 2.52; 95% CI 2.39-2.64; p < 0.0001). In addition to year of diagnosis, age and Charlson score were strong predictors of EM usage (p < 0.0001).

Other predictors of EM usage were hospital type and insurance provider:

  • patients who were treated at comprehensive cancer centers (OR = 0.63; 95% CI 0.60-0.66; p < 0.0001)
  • patients who have personal health insurance (OR = 0.90 95% CI 0.88-0.83; p < 0.0001) 

There was a weak but significant association of patient race, income level, and area of residence, as well as hospital location, with EM.

In summary, the researchers commented, “In recent years, low-risk prostate cancer has been increasingly managed with EM, especially in older patients or patients with multiple comorbidities, who are least likely to benefit from active treatment. Unexpectedly, hospital type and insurance provider also predict EM usage, calling into question whether nonclinical factors are influencing EM selection.”

Source: Maurice, MJ, Abouassaly R, Zhu H, et al. A population-based study of expectant management utilization and its predictors for low-risk prostate cancer. Abstract presented at 2014 Genitourinary Cancers Symposium; San Francisco, California. January 30, 2014.