The Association of Patient and Disease Characteristics with the Overtreatment of Low-risk Prostate Cancer from 2010 to 2016

Overview

Journal Prostate Cancer Prostatic Dis

Specialties Oncology
Urology

Date 2024 Mar 30

PMID 38555410

Authors

Cooper Desmond

Sumedh Kaul

Aaron Fleishman

Ruslan Korets

Peter Chang

Andrew Wagner

Simon P Kim

Nima Aghdam

Aria F Olumi

Boris Gershman

Affiliations

Soon will be listed here.

Abstract

Background: Although active surveillance is the preferred management for low-risk prostate cancer (PCa), some men remain at risk of overtreatment with definitive local therapy. We hypothesized that baseline characteristics may be associated with overtreatment and represent a potential source of health disparities. We therefore examined the associations of patient and disease characteristics with the surgical overtreatment of low-risk PCa.

Methods: We identified men aged 45-75 years with cT1 cN0 cM0 prostate adenocarcinoma with biopsy Gleason score 6 and PSA < 10 ng/ml from 2010-2016 in the National Cancer Database (NCDB) and who underwent radical prostatectomy (RP). We evaluated the associations of baseline characteristics with clinically insignificant PCa (iPCa) at RP (i.e., "overtreatment"), defined as organ-confined (i.e., pT2) Gleason 3 + 3 disease, using multivariable logistic regression.

Results: We identified 36,088 men with low-risk PCa who underwent RP. The unadjusted rate of iPCa decreased during the study period, from 54.7% in 2010 to 40.0% in 2016. In multivariable analyses adjusting for baseline characteristics, older age (OR 0.98, 95% CI 0.97-0.98), later year of diagnosis (OR 0.62, 95% CI 0.57-0.67 for 2016 vs. 2010), Black race (OR 0.85, 95% CI 0.79-0.91), treatment at an academic/research program (OR 0.82, 95% CI 0.73-0.91), higher PSA (OR 0.91, 95% CI 0.90-0.92), and higher number of positive biopsy cores (OR 0.87, 95% CI 0.86-0.88) were independently associated with a lower risk of overtreatment (iPCa) at RP. Conversely, a greater number of biopsy cores sampled (OR 1.01, 95% CI 1.01-1.02) was independently associated with an increased risk of overtreatment (iPCa) at RP.

Conclusions: We observed an ~27% reduction in rates of overtreatment of men with low-risk PCa over the study period. Several patient, disease, and structural characteristics are associated with detection of iPCa at RP and can inform the management of men with low-risk PCa to reduce potential overtreatment.

References

Chen R, Rumble R, Loblaw D, Finelli A, Ehdaie B, Cooperberg M . Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement. J Clin Oncol. 2016; 34(18):2182-90. DOI: 10.1200/JCO.2015.65.7759. View

Sanda M, Cadeddu J, Kirkby E, Chen R, Crispino T, Fontanarosa J . Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part I: Risk Stratification, Shared Decision Making, and Care Options. J Urol. 2017; 199(3):683-690. DOI: 10.1016/j.juro.2017.11.095. View

Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch M, De Santis M . EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2016; 71(4):618-629. DOI: 10.1016/j.eururo.2016.08.003. View

Mohler J . The 2010 NCCN clinical practice guidelines in oncology on prostate cancer. J Natl Compr Canc Netw. 2010; 8(2):145. DOI: 10.6004/jnccn.2010.0010. View

Mahal B, Butler S, Franco I, Spratt D, Rebbeck T, DAmico A . Use of Active Surveillance or Watchful Waiting for Low-Risk Prostate Cancer and Management Trends Across Risk Groups in the United States, 2010-2015. JAMA. 2019; 321(7):704-706. PMC: 6439610. DOI: 10.1001/jama.2018.19941. View

Katz J, Chinea F, Patel V, Balise R, Venkatramani V, Gonzalgo M . Disparities in Hispanic/Latino and non-Hispanic Black men with low-risk prostate cancer and eligible for active surveillance: a population-based study. Prostate Cancer Prostatic Dis. 2018; 21(4):533-538. DOI: 10.1038/s41391-018-0057-6. View

Deka R, Parsons J, Simpson D, Riviere P, Nalawade V, Vitzthum L . African-American men with low-risk prostate cancer treated with radical prostatectomy in an equal-access health care system: implications for active surveillance. Prostate Cancer Prostatic Dis. 2020; 23(4):581-588. DOI: 10.1038/s41391-020-0230-6. View

Maurice M, Sundi D, Schaeffer E, Abouassaly R . Risk of Pathological Upgrading and Up Staging among Men with Low Risk Prostate Cancer Varies by Race: Results from the National Cancer Database. J Urol. 2016; 197(3 Pt 1):627-631. PMC: 6513017. DOI: 10.1016/j.juro.2016.08.095. View

Faisal F, Sundi D, Cooper J, Humphreys E, Partin A, Han M . Racial disparities in oncologic outcomes after radical prostatectomy: long-term follow-up. Urology. 2014; 84(6):1434-41. PMC: 4337854. DOI: 10.1016/j.urology.2014.08.039. View

10.

Dinizo M, Shih W, Kwon Y, Eun D, Reese A, Giusto L . Multi-institution analysis of racial disparity among African-American men eligible for prostate cancer active surveillance. Oncotarget. 2018; 9(30):21359-21365. PMC: 5940363. DOI: 10.18632/oncotarget.25103. View

11.

Jalloh M, Myers F, Cowan J, Carroll P, Cooperberg M . Racial variation in prostate cancer upgrading and upstaging among men with low-risk clinical characteristics. Eur Urol. 2014; 67(3):451-7. DOI: 10.1016/j.eururo.2014.03.026. View

12.

Moyer V . Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012; 157(2):120-34. DOI: 10.7326/0003-4819-157-2-201207170-00459. View

13.

Halpern J, Shoag J, Artis A, Ballman K, Sedrakyan A, Hershman D . National Trends in Prostate Biopsy and Radical Prostatectomy Volumes Following the US Preventive Services Task Force Guidelines Against Prostate-Specific Antigen Screening. JAMA Surg. 2016; 152(2):192-198. DOI: 10.1001/jamasurg.2016.3987. View

14.

Jemal A, Culp M, Ma J, Islami F, Fedewa S . Prostate Cancer Incidence 5 Years After US Preventive Services Task Force Recommendations Against Screening. J Natl Cancer Inst. 2020; 113(1):64-71. PMC: 7781461. DOI: 10.1093/jnci/djaa068. View

15.

Deka R, Courtney P, Parsons J, Nelson T, Nalawade V, Luterstein E . Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance. JAMA. 2020; 324(17):1747-1754. PMC: 7610194. DOI: 10.1001/jama.2020.17020. View

16.

Vigneswaran H, Mittelstaedt L, Crippa A, Eklund M, Vidal A, Freedland S . Progression on active surveillance for prostate cancer in Black men: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2021; 25(2):165-173. DOI: 10.1038/s41391-021-00425-1. View

17.

Iremashvili V, Soloway M, Rosenberg D, Manoharan M . Clinical and demographic characteristics associated with prostate cancer progression in patients on active surveillance. J Urol. 2012; 187(5):1594-9. DOI: 10.1016/j.juro.2011.12.082. View

18.

Sundi D, Faisal F, Trock B, Landis P, Feng Z, Ross A . Reclassification rates are higher among African American men than Caucasians on active surveillance. Urology. 2014; 85(1):155-60. PMC: 4275346. DOI: 10.1016/j.urology.2014.08.014. View

19.

Tosoian J, Mamawala M, Epstein J, Landis P, Macura K, Simopoulos D . Active Surveillance of Grade Group 1 Prostate Cancer: Long-term Outcomes from a Large Prospective Cohort. Eur Urol. 2020; 77(6):675-682. DOI: 10.1016/j.eururo.2019.12.017. View

20.

Ritch C, Morrison B, Hruby G, Coard K, Mayhew R, Aiken W . Pathological outcome and biochemical recurrence-free survival after radical prostatectomy in African-American, Afro-Caribbean (Jamaican) and Caucasian-American men: an international comparison. BJU Int. 2012; 111(4 Pt B):E186-90. DOI: 10.1111/j.1464-410X.2012.11540.x. View