Login to Access Video or Poster Abstract: MP43-04
Sources of Funding: none

Introduction

Since the 2011 U.S. Preventative Services Task Force (USPSTF) recommendation against prostate cancer (PCa) screening, there have been various modifications observed in the practice of urology. We hypothesized that low risk PCa is managed more conservatively secondary to the USPSTF recommendation and sought to evaluate the rates of non-definitive management (NDM) during this era.

Methods

We performed a retrospective cohort study of 105,295 patients in the National Cancer Database diagnosed with NCCN low risk PCa from 2010-2013. Our primary endpoint was to identify rates of NDM {active surveillance (AS) + watchful waiting (WW)} before and after the USPSTF recommendation against PSA screening in 2011. We performed multivariate logistic regression analysis to evaluate patient specific factors contributing to this form of management. These included age, race, clinical stage, facility volume, facility type, insurance, Charlson comorbidity index, PSA, year of diagnosis, geographic location, and neighborhood income.

Results

Of the 105,295 patients with low risk disease, 15,423 (15%) elected NDM versus 89,872 (85%) who elected active treatment. Of the 15,423 patients who elected NDM, 75% were on AS and 25% on WW. Median age of patients electing NDM versus treatment was 65 and 62 years old, respectively. As shown in Figure 1, the rate of NDM in years prior to the USPSTF recommendation was 10.1% and 12.9% in 2010 and 2011, respectively (OR 1.36, p<0.001). NDM increased in the years following the USPSTF recommendation of 2011 with the rate of NDM of 17.04% in 2012 (OR 1.92, p<0.001), and increasing to 21.6% in 2013 (OR 2.56, p<0.001). At the current rate of change of 3.85% per year, NDM utilization would reach 50% by the year 2021.

Conclusions

Since the USPSTF recommendation, NDM utilization has significantly increased in patients with low risk PCa. However, this data highlights the continued underutilization of surveillance in this patient population.

Funding

none