Increasing rate of non-interventional treatment management in localized prostate cancer candidates for active surveillance
The rate of non-interventional treatment (NIT) in prostate cancer (PCa) active surveillance (AS) candidates were shown to be on the rise. However, contemporary data are unavailable. To address this void, we examined NIT rate in AS candidates between 2010-2014, within 16 Surveillance Epidemiology and End Results (SEER) registries.
We identified 23,360 PCa patients that fulfilled the University of California, San Francisco AS criteria (prostate specific antigen [PSA] <10ng/ml, clinical T stage ?T2a, Gleason score ?6, and percent of positive cores <33%). Annual NIT rates, as well as the patient distribution according to PSA, age, number of positive cores and clinical T stage were studied. Multivariable logistic regression analysis (MLR) tested NIT predictors. LOESS plots graphically depicted the effect of patient and tumour characteristics on NIT rate. </p>
Between 2010-2014, NIT rate increased from 30.2 to 57.5% (p=0.004). Within 16 SEER-registries, NIT rates ranged from 25.9 to 62%. NIT rate increased uniformly within all examined registries. Of patient and tumour characteristics (PSA >4ng/ml, cT2a and >1 positive core) only the proportion of NIT patients aged <65 years increased over time: 47.3 to 53.2% (p=0.03). In MLR predicting NIT rate, older age (odd ratio [OR]: 1.05), more contemporary year of diagnosis (OR: 1.40), as well as unmarried (OR: 1.45) and uninsured (OR: 2.41) status were independent predictors. The graphical representation of NIT rates showed increasing rate with older age, decreasing rate with higher number of positive cores and stable rate according of baseline PSA value. </p>
The rate of NIT as markedly increased across all examined SEER-registries. Nonetheless, very important differences distinguish high-end NIT users from low-end NIT users. PCa characteristics of NIT patients remained unchanged overtime. However, in addition to geographical differences in NIT rates, patient characteristic such as age, marital and insurance status represent potential NIT access barriers.