Journal article
Intensity of observation with active surveillance or watchful waiting in men with prostate cancer in the United States
Prostate cancer and prostatic diseases, Vol.26(2), pp.395-402
06/2023
DOI: 10.1038/s41391-022-00580-z
PMID: 35882950
Abstract
Background Population-based studies assessing various active surveillance (AS) protocols for prostate cancer, to date, have inferred AS participation by the lack of definitive treatment and use of post-diagnostic testing. This is problematic as evidence suggests that most men do not adhere to AS protocols. We sought to develop a novel method of identifying men on AS or watchful waiting (WW) independent of post-diagnostic testing and aimed to identify possible predictors of follow-up intensity in men on AS/WW. Methods A predictive model was developed using SEER watchful waiting data to identify men >= 66 years on AS between 2010-2015, irrespective of post-diagnostic testing, and applied to SEER-Medicare database. AS intensity among different variables including age, prostate-specific antigen (PSA) level, number of total and positive biopsy cores, Charlson comorbidity index, race (Black vs. non-Black), US census region, and county poverty, income, and education levels were compared using multivariable regression analyses for PSA testing, surveillance biopsy, and magnetic resonance imaging (MRI). Results A total of 2238 men were identified as being on AS. Of which, 81%, 33%, and 10% had a PSA test, surveillance biopsy, and MRI scan within 1-2 years, respectively. On multivariable analyses, Black men were less likely to have a PSA test (adjusted rate ratio [ARR] 0.60, 95% CI: 0.53-0.69), MRI scan (ARR 0.40, 95% CI: 0.24-0.68), and surveillance biopsy (ARR 0.71, 95% CI: 0.55-0.92) than non-Black men. Men within the highest income quintile were more likely to undergo PSA test (ARR 1.16, 95% CI: 1.05-1.27) and MRI scan (ARR 1.60, 95% CI 1.15-2.27) compared to men with the lowest income. Conclusions Black men and men with lower incomes on AS underwent less rigorous monitoring. Further study is needed to understand and ameliorate differences in AS rigor stemming from sociodemographic differences.
Details
- Title: Subtitle
- Intensity of observation with active surveillance or watchful waiting in men with prostate cancer in the United States
- Creators
- Bashir Al Hussein Al Awamlh - Vanderbilt UniversityXian Wu - Weill Cornell MedicineDaniel A. Barocas - Vanderbilt UniversityKelvin A. Moses - Vanderbilt UniversityRichard M. Hoffman - Univ Iowa, Dept Med, Carver Coll Med, Iowa City, IA 52242 USASpyridon P. Basourakos - Weill Cornell MedicinePatrick Lewicki - Weill Cornell MedicineWoodson W. Smelser - Vanderbilt UniversityCamilo Arenas-Gallo - Case Western Reserve UniversityJonathan E. Shoag - Weill Cornell Medicine
- Resource Type
- Journal article
- Publication Details
- Prostate cancer and prostatic diseases, Vol.26(2), pp.395-402
- Publisher
- Springer Nature
- DOI
- 10.1038/s41391-022-00580-z
- PMID
- 35882950
- ISSN
- 1365-7852
- eISSN
- 1476-5608
- Number of pages
- 8
- Grant note
- Vinney Scholars Award Damon Runyon Cancer Research Foundation Physician-Scientist Training Award Frederick J. and Theresa Dow Fund of the New York Community Trust
- Language
- English
- Electronic publication date
- 07/26/2022
- Date published
- 06/2023
- Academic Unit
- Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984359826902771
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