ABSTRACT
Objectives
To investigate sociodemographic factors influencing decision of initially active surveillance
(AS) prostate cancer (CaP) patients to opt for definitive therapy, and, specifically,
choice of radical prostatectomy (RP) versus radiation therapy (XRT).
Methods
The Surveillance, Epidemiology, and End Results (SEER) Prostate with Watchful Waiting
database was used to identify AS patients diagnosed with NCCN low-risk CaP between
2010 and 2015. We sought to determine predictors of treatment type using multivariable
logistic regression analyses.
Results
Out of 32,874 men included, 21,255 (64.7%) underwent delayed treatment, with 3,751
(17.6%) and 17,463 (82.2%) opting for RP and XRT, respectively. Patients who were
married (Odds Ratio [OR]: 1.18, P <.001), insured (OR 2.94, P <.001), of higher socioeconomic status (OR 1.67 for highest vs lowest, P <.01), and residing in a Southeastern or Midwestern region (ORs 1.26 and 1.22 vs
Northeast, respectively, P <.01) were significantly more likely to undergo definitive intervention. A significant
interaction between patient race and marital/socioeconomic statuses on the decision-making
process was identified. Decision for XRT (vs RP) was more likely in older (OR 11.6
for 70-79 vs 50-59 years, P <.01), unmarried (OR 1.89, P <.01), African American (OR 1.41, P .018), and higher socioeconomic status (OR 1.54 for highest versus lowest quartile,
P <.01) patients.
Conclusion
The majority of patients initially treated with AS underwent delayed treatment. After
accounting for pathologic characteristics, the interaction of sociodemographic factors
including race, socioeconomic status, marital status, insurance status, and region
of residence are significantly associated with the likelihood of undergoing definitive
therapy.
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Article info
Publication history
Published online: February 09, 2021
Accepted:
January 25,
2021
Received:
November 16,
2020
Footnotes
Previous Presentations: Accepted in abstract format at 2020 AUA Annual and 2020 Southeast AUA meetings.
Funding Sources: None.
Conflicts of Interest: The authors declare no relevant conflicts of interest.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
