Contemporary Trends in Active Surveillance for Newly Diagnosed Low-Risk Prostate Cancer
A population-based study on AS adoption among men with low-risk LPC, exploring racial and geographical differences, treatment choices, and QOL measures over 18 months.
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Presentation Transcript
The Research Question 1) What is the contemporary prevalence of Active Surveillance (AS) adoption among men newly diagnosed with low-risk localized prostate cancer (LPC)? 2) Are there any racial and/or geographical differences in AS adoption, adherence to AS protocol and switch rates and time to curative treatment over 18 months follow-up? 3) What are the differences in quality-of-life (QOL) measures between the AS group and curative treatment group over the course of 18 months, overall and by race?
Research Design and Method Design: Longitudinal cohort study Setting: Population-based sample recruited from 2 SEER Cancer Registries (Metro-Detroit & State of Georgia) Participants: Black and white men 75 years, newly diagnosed (2014-2017) low-risk LPC (PSA<10, Gleason 6, & stage T2a) Instrument: Self-administered, mailed survey at: Baseline (soon after diagnosis) 18 months follow-up (after baseline) Main Outcome Measure: Treatment choice Quality of life
What the Research Found In this population-based sample (~1700), ~55% of patients with low-risk LPC chose observation initially, most chose AS This represents much higher rate of uptake of AS comparing to 10-15% 5 to 10 years ago, even higher than other recent reports from non-population-based cohort 35-45% Treatment choice was associated with race and geographical location Black men chose AS less often than white men (p=0.001) Black men choose radiation more often than white men with this difference being larger in Georgia (p=0.016) Data collection is ongoing for the 18 month-follow-up of QOL and AS adherence and switch rates and reasons for the switch
What this means for Clinical Practice Our population-based cohort confirmed the recent reports of upward trend of AS adoption among men with newly diagnosed low-risk LPC This suggests both men and their physicians are more accepting of AS than previously reported The reasons for the racial and geographical differences in treatment pattern of low-risk LPC deserve more research so that unwanted treatment patterns could be minimized Comparison data on QOL between AS group and curative treatment group over 18 month-follow-up to be analyzed/announced
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