Login to Access Video or Poster Abstract: MP14-01
Sources of Funding: none

Introduction

A critical means of reducing the morbidity associated with screening for prostate cancer (CaP) is uncoupling diagnosis from treatment. In some men, treatment risks may outweigh benefits. We sought to understand the current treatment landscape of men with very low or low risk (VLoLR) CaP and to determine factors associated with receiving treatment in a contemporary national cohort. _x000D_

Methods

Using the National Cancer Database for the years 2010-2013, men with CaP were categorized into risk groups using NCCN criteria by PSA, Gleason score, cT stage, and number of positive cores. In men with VLoLR CaP, radical prostatectomy (RP), radiotherapy (RT), or androgen deprivation therapy (ADT) within 1 year was considered immediate treatment. Men managed with active surveillance (AS), watchful waiting (WW), or no treatment (NoTx) were also analyzed. Treatment patterns by age, comorbidities, and diagnosis year were assessed. Logistic regression modeling was used to determine factors associated with higher likelihood of receiving any treatment.

Results

Of 448,810 men diagnosed with CaP, 46,290 (11.9%) had very low risk and 60,122 (15.5%) had low risk CaP. In this combined VLoLR Cap cohort, overall median age was 62 with 34.6% of men being older than 65. Overall, 74.8% of men with VLoLR CaP received primary treatment within 1 year of diagnosis. Primary treatment rates declined over time while management with AS/WW/NoTx increased (Figure 1). In men >65 with VLoLR CaP, 28.9% had RP, 35.9% got RT, and 19.2% had AS/WW/NoTx. In men >75, only 5.3% received RP, 39.9% got RT, and 25.4% had AS/WW/NoTx. Age >65 (OR 0.55 95% CI 0.53-0.57), being treated at an academic center (OR 0.68, 95% CI 0.66-0.71), and progressive years after 2010 were associated with lower odds of treatment (Table 1).

Conclusions

Significant numbers of men with VLoLR CaP underwent primary treatment during 2010-2013, including older men, in whom there is no established benefit to treatment. However, a trend toward more conservative management is apparent.

Funding

none