Sociodemographic and Clinical Predictors of Switching to Active Treatment among a Large, Ethnically Diverse Cohort of Men with Low Risk Prostate Cancer on Observational Management

Scott P Kelly; Stephen K Van Den Eeden; Richard M Hoffman; David S Aaronson; Tania Lobo; George Luta; Amethyst D Leimpter; Jun Shan; Arnold L Potosky; Kathryn L Taylor

doi:10.1016/j.juro.2016.04.045

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Sociodemographic and Clinical Predictors of Switching to Active Treatment among a Large, Ethnically Diverse Cohort of Men with Low Risk Prostate Cancer on Observational Management

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Sociodemographic and Clinical Predictors of Switching to Active Treatment among a Large, Ethnically Diverse Cohort of Men with Low Risk Prostate Cancer on Observational Management

Scott P Kelly, Stephen K Van Den Eeden, Richard M Hoffman, David S Aaronson, Tania Lobo, George Luta, Amethyst D Leimpter, Jun Shan, Arnold L Potosky and Kathryn L Taylor

The Journal of urology, Vol.196(3), pp.734-740

09/2016

DOI: 10.1016/j.juro.2016.04.045

PMCID: PMC5094279

PMID: 27091570

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Abstract

We determined the clinical and sociodemographic predictors of beginning active treatment in an ethnically diverse population of men with low risk prostate cancer initially on observational treatment. We retrospectively studied men diagnosed with low risk prostate cancer between 2004 and 2012 at Kaiser Permanente Northern California who did not receive any treatment within the first year of diagnosis and had at least 2 years of followup. We used Cox proportional hazards regression models to determine factors associated with time from diagnosis to active treatment. We identified 2,228 eligible men who were initially on observation, of whom 27% began active treatment during followup at a median of 2.9 years. NonHispanic black men were marginally more likely to begin active treatment than nonHispanic white men independent of baseline and followup clinical measures (HR 1.3, 95% CI 1.0–1.7). Among men who remained on observation nonHispanic black men were rebiopsied within 24 months of diagnosis at a slightly lower rate than nonHispanic white men (HR 0.70, 95% CI 0.6–1.0). Gleason grade progression (HR 3.3, 95% CI 2.7–4.1) and PSA doubling time less than 48 months (HR 2.9, 95% CI 2.3–3.7) were associated with initiation of active treatment independent of race. Sociodemographic factors such as ethnicity and education may independently influence the patient decision to pursue active treatment and serial biopsies during active surveillance. These factors are important for further studies of prostate cancer treatment decision making.

African Americans

disease progression

early detection of cancer

watchful waiting

prostatic neoplasms

Details

Title: Subtitle: Sociodemographic and Clinical Predictors of Switching to Active Treatment among a Large, Ethnically Diverse Cohort of Men with Low Risk Prostate Cancer on Observational Management
Creators: Scott P Kelly - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C
Stephen K Van Den Eeden - Department of Urology, Kaiser Oakland Medical Center, Northern California, Oakland, California
Richard M Hoffman - Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
David S Aaronson - Department of Urology, Kaiser Oakland Medical Center, Northern California, Oakland, California
Tania Lobo - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C
George Luta - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C
Amethyst D Leimpter - Division of Research, Kaiser Permanente Northern California, Oakland, California
Jun Shan - Division of Research, Kaiser Permanente Northern California, Oakland, California
Arnold L Potosky - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C
Kathryn L Taylor - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C
Resource Type: Journal article
Publication Details: The Journal of urology, Vol.196(3), pp.734-740
DOI: 10.1016/j.juro.2016.04.045
PMID: 27091570
PMCID: PMC5094279
NLM abbreviation: J Urol
ISSN: 0022-5347
eISSN: 1527-3792
Publisher: Elsevier Inc
Language: English
Date published: 09/2016
Academic Unit: Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984094331302771

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