Sociodemographic and Clinical Predictors of Switching to Active Treatment among a Large, Ethnically Diverse Cohort of Men with Low Risk Prostate Cancer on Observational Management

Abstract

Purpose To determine the clinical and sociodemographic predictors of beginning an active treatment among an ethnically diverse population of men with low-risk prostate cancer initially on observational management. Materials and Methods We retrospectively studied men diagnosed with low-risk prostate cancer between 2004 and 2012 at Kaiser Permanente Northern California, who did not receive any treatment within the first year of diagnosis and had at least two years of follow-up. We used Cox proportional hazards regression models to determine factors associated with time from diagnosis until active treatment. Results We identified 2,228 eligible men who were initially on observation, and 27% began an active treatment during follow-up (median 2.9 years). Non-Hispanic Black men were marginally more likely to begin an active treatment (hazard ratio [HR] 1.3, 95% CI 1.0–1.7) than non-Hispanic White men, independent of baseline and follow-up clinical measures. Among men who remained on observation, non-Hispanic Black men were re-biopsied within 24 months of diagnosis at slightly lower rates than non-Hispanic White men (HR 0.70, 95% CI 0.6–1.0). Gleason grade progression (HR 3.3, 95% CI 2.7–4.1) and a PSA doubling time < 48 months (HR 2.9, 95% CI 2.3–3. 7) were associated with initiation of active treatment, independent of race. Conclusions Sociodemographic factors, such as ethnicity and education, may independently influence a patient's decision to pursue active treatment and their utilization of serial biopsies during active surveillance. These factors are important in further studies of prostate cancer treatment decision making.

Why men with a low-risk prostate cancer select and stay on active surveillance: A qualitative study

“…[9–12] Additionally, studies suggest that men may not be adherent with monitoring protocols, particularly in obtaining surveillance biopsies. [13, 14] While AS may mitigate the harms of overdiagnosis, lack of adherence with surveillance monitoring could lead to more men progressing to advanced-stage, incurable disease.…”

Indications for and transitioning to secondary treatment while on active surveillance for prostate cancer

“…In addition to eligibility criteria, follow-up strategies, and thresholds for intervention also contributed to decision for radical treatment ( 41 ). Sociodemographic factors including race, age, education level and comorbidities have been found to be associated with AS discontinuation ( 42 - 44 ). Kelly et al ( 42 ) found that black men were more likely to switch to active treatment, which has been described in prior studies ( 44 ).…”

“…Sociodemographic factors including race, age, education level and comorbidities have been found to be associated with AS discontinuation ( 42 - 44 ). Kelly et al ( 42 ) found that black men were more likely to switch to active treatment, which has been described in prior studies ( 44 ). Additionally, the authors found black men were less likely to undergo serial re-biopsy perhaps explaining the higher rates of eventual treatment.…”

Multiparametric Magnetic Resonance Imaging for Active Surveillance of Prostate Cancer

“…In one large retrospective analysis of 24.450 patients with low risk PCa suitable for AS, over half (55%) selected definitive treatment over AS ( 46 ). Kelly et al ( 47 ) found 27% of patients initially on AS opted for definitive treatment within 2.9 years of follow-up. Although practice patterns have shifted over the last decade towards more conservative treatments, the role of mpMRI in maintaining men on AS has not been explored.…”