Objective
To characterize the role of clinical and sociodemographic factors in the use of conservative
management for localized prostate cancer in the US between 2010 and 2015, and to understand
how those factors evolved in light of the recent national increase in conservative
management rates.
Methods
Data from the Surveillance, Epidemiology, and End Results Program “Prostate with Watchful
Waiting Database,” where conservative treatment was delineated by a distinct classifier,
was used to evaluate factors associated with electing for conservative management
at initial diagnosis (2010-2015). Men aged ≥40 years with cT1-T2a and T2NOS with Gleason
score 3 + 3 and 3 + 4 were included (n = 118,415). Multivariable logistic regression was used to determine the association
between clinical and sociodemographic factors and electing conservative management.
Results
Between 2010 and 15, a total of 22,099 (18.6%) men were managed conservatively. Mean
age of men managed conservatively decreased from 66.6 to 64.6 years, and median prostate-specific
antigen (PSA) increased from 5.7 to 6.0 ng/mL, P <.0001. Men with lower income experienced a greater increase in conservative management
rates compared to those with high income (152% vs 72% for third and fifth [richest]
income quintiles, respectively). On multivariable analysis, Gleason score 3 + 3, older
age, lower PSA, more recent year, treatment in the West, and higher levels of county
income were significantly associated with conservative management.
Conclusion
Characteristics of men undergoing conservative management are rapidly changing. Younger
men, men with higher PSAs, and men of all incomes are increasingly being managed conservatively.
Narrowing of income-based disparities with concurrent broadening of patients considered
eligible for surveillance is encouraging.
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Article info
Publication history
Published online: January 13, 2020
Accepted:
December 6,
2019
Received:
July 21,
2019
Footnotes
Funding: JS, JCH, and DS are supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. JS is supported by Damon Runyon Cancer Research Foundation Physician Scientist Training Award. XM is partially reported by the following grant: Clinical and Translational Science Center at Weill Cornell Medicine (1-UL1-TR002384-01).
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© 2019 Elsevier Inc. All rights reserved.
