scholarly journals Conservative management of low‐risk prostate cancer among young versus older men in the United States: Trends and outcomes from a novel national database

Cancer ◽  
2019 ◽  
Vol 125 (19) ◽  
pp. 3338-3346 ◽  
Author(s):  
Amandeep R. Mahal ◽  
Santino Butler ◽  
Idalid Franco ◽  
Vinayak Muralidhar ◽  
Dalia Larios ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Conservative Management ◽  
Older Men ◽  
The United States ◽  
Low Risk ◽  
National Database ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

scholarly journals Cost Implications and Complications of Overtreatment of Low-Risk Prostate Cancer in the United States

2015 ◽  
Vol 13 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Ayal A. Aizer ◽  
Xiangmei Gu ◽  
Ming-Hui Chen ◽  
Toni K. Choueiri ◽  
Neil E. Martin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
The United States ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Cost Implications

Conservative management of low-risk prostate cancer among young versus older men in the United States: Trends and outcomes from a novel national database.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 12-12 ◽  
Author(s):  
Amandeep R Mahal ◽  
Santino Butler ◽  
Idalid Ivy Franco ◽  
Luke Roy George Pike ◽  
Shuang Zhao ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Conservative Management ◽  
The United States ◽  
Low Risk ◽  
Definitive Treatment ◽  
Short Term ◽  
Initial Management ◽  
Positive Biopsy ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

12 Background: The optimal management for men age ≤55 with low-risk prostate cancer (PCa) is debated given quality of life implications with definitive treatment versus potential missed opportunity for cure with conservative management. We sought to define rates of conservative management for low-risk PCa and associated short-term outcomes in young versus older men in the United States (U.S.). Methods: The Surveillance, Epidemiology, and End Results (SEER) Prostate with Active Surveillance/Watchful Waiting (AS/WW) Database identified 50,302 men diagnosed with low-risk PCa from 2010-2015. AS/WW rates in the U.S. were stratified by age (≤55 versus ≥56). Prostate cancer-specific mortality (PCSM)and overall mortality were defined by initial management type (AS/WW versus definitive treatment [referent]) and age. This non-public data was released by the SEER custom data group. Results: AS/WW utilization increased from 8.61% in 2010 to 34.56% in 2015 among men age ≤55 (Ptrend< 0.001) and from 15.99% to 43.81% among men age ≥56 (Ptrend< 0.001). Among patients with ≤2 positive biopsy cores, AS/WW rates increased from 12.90% to 48.78% for men age ≤55 and from 21.85% to 58.01% for men age ≥56. Among patients with ≥3 positive biopsy cores, AS/WW rates increased from 3.89% to 22.45% for men age ≤55 and from 10.05% to 28.49% for men age ≥56 (all Ptrend< 0.001). Five-year PCSM rates were below 0.30% across age and initial management type subgroups. Conclusions: AS/WW rates quadrupled for patients age ≤55 from 2010-2015, with favorable short-term outcomes. These findings demonstrate the short-term safety and increasing acceptance of AS/WW for both younger and older patients. However, there are still higher absolute rates of AS/WW in older patients (P < 0.001), suggesting some national ambivalence toward AS/WW in younger patients.

Overtreatment of low-risk prostate cancer in the United States: Incidence, cost, complications, and implications for the screening debate.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 161-161 ◽  
Author(s):  
Ayal A. Aizer ◽  
Xiangmei Gu ◽  
Toni K. Choueiri ◽  
Neil E. Martin ◽  
Jim C. Hu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Life Expectancy ◽  
Specific Antigen ◽  
Expectant Management ◽  
The United States ◽  
Low Risk ◽  
Definitive Treatment ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

161 Background: The National Comprehensive Cancer Network (NCCN) recommends active surveillance as the sole option for men with low-risk prostate cancer (LRPC) and a life expectancy <10 years. We sought to describe the incidence, risk factors, cost, and morbidity related to overtreatment of LRPC within the United States. Methods: We used the Surveillance, Epidemiology and End Results (SEER)-Medicare Program to identify 11,744 men ≥66 years with LRPC diagnosed from 2004-2007. Expected survival was estimated using the 2007 Social Security Life Table and was increased and decreased by 50% in men in the upper and lower quartiles of comorbidity, respectively, as specified by the NCCN. Overtreatment was definitive treatment in men with LRPC and life expectancy <10 years. Costs were the amount paid by Medicare in the year following minus the year prior to diagnosis. Toxicities were defined as relevant Medicare diagnoses or interventions. Results: Of 3001 men with LRPC and a life expectancy <10 years, 2011 (67%) were treated definitively. On multivariable logistic regression, men overtreated for prostate cancer were more likely to be younger (p<.001), white (vs black, OR 1.44, 95% CI 1.03-2.02, p=.03), married (OR 1.30, 95% CI 1.05-1.61, p=.02), urban (trend, OR 1.40, 95% CI 0.98-2.00, p=.06), have higher Elixhauser comorbidity (p<.001), and have a higher clinical stage (T2 vs T1, OR 1.57, 95% CI 1.19-2.07, p=.001) and prostate-specific antigen level (OR 1.02, 95% CI 1.02-1.02, p<.001). Relative to expectant management, the mean added cost per definitive treatment was $15,308. When extrapolated nationally the cumulative net cost of overtreatment in men ≥66 years is $32 million per annum. Long-term urinary, erectile, and bowel toxicity occurred in 59.2% and 50.0%, 47.9% and 19.7%, and 7.1% and 17.8% of prostatectomy and radiation patients, respectively. Conclusions: Overtreatment of prostate cancer is partially driven by sociodemographic factors and occurs in a high percentage of men with LRPC and limited life expectancy, with marked impact on patient quality of life and health care costs. Efforts to enhance appropriate management of LRPC would reduce the harms associated with screening.

scholarly journals Active Surveillance for Black Men with Low-Risk Prostate Cancer in the United States

2019 ◽  
Vol 381 (26) ◽  
pp. 2581-2582 ◽  
Author(s):  
Bashir Al Hussein Al Awamlh ◽  
Xiaoyue Ma ◽  
Paul Christos ◽  
Jim C. Hu ◽  
Jonathan E. Shoag
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Black Men ◽  
Active Surveillance ◽  
The United States ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer
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