Uncovering the Changing Treatment Landscape for Low-risk Prostate Cancer in the USA from 2010 to 2020
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Uncovering the Changing Treatment Landscape for Low-risk Prostate Cancer in the USA from 2010 to 2020 : Insights from the National Cancer Data Base. / Beatrici, Edoardo; Labban, Muhieddine; Stone, Benjamin V; Filipas, Dejan K; Reis, Leonardo O; Lughezzani, Giovanni; Buffi, Nicolò M; Kibel, Adam S; Cole, Alexander P; Trinh, Quoc-Dien.
In: EUR UROL, Vol. 84, No. 6, 12.2023, p. 527-530.Research output: SCORING: Contribution to journal › Short publication › Research › peer-review
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TY - JOUR
T1 - Uncovering the Changing Treatment Landscape for Low-risk Prostate Cancer in the USA from 2010 to 2020
T2 - Insights from the National Cancer Data Base
AU - Beatrici, Edoardo
AU - Labban, Muhieddine
AU - Stone, Benjamin V
AU - Filipas, Dejan K
AU - Reis, Leonardo O
AU - Lughezzani, Giovanni
AU - Buffi, Nicolò M
AU - Kibel, Adam S
AU - Cole, Alexander P
AU - Trinh, Quoc-Dien
N1 - Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.
PY - 2023/12
Y1 - 2023/12
N2 - The management of prostate cancer (PCa) has evolved from a paradigm of "treat when caught early" to "treat only when necessary". Despite inconsistency in its use, active surveillance has evolved over the past two decades into the gold standard for management of low-risk PCa. Our objective was to investigate whether the use of expectant management (active surveillance, watchful waiting, no treatment) as a first-line approach for low-risk PCa has increased over the past decade. We queried the US National Cancer Data Base for men diagnosed with localized PCa between 2010 and 2020. Two multivariable logistic regression models with different two-way interaction terms (year of diagnosis × D'Amico risk classification, and year of diagnosis × International Society of Urological Pathology [ISUP] grade group) were fitted to predict the probability of undergoing expectant management versus active treatment. The predicted probability of expectant management increased from 13.7% in 2010 to 64.4% in 2020 for men with low-risk PCa, and from 12.9% in 2010 to 61.6% in 2020 for ISUP grade group 1 PCa (both pinteraction < 0.001). The frequency of expectant management for low-risk PCa has increased dramatically during the past decade. We expect this trend to further increase owing to the growing awareness of the harms of overtreatment of indolent disease. PATIENT SUMMARY: We examined the use of expectant management for prostate cancer between 2010 and 2020 in a large hospital-based registry from the USA. We found that the proportion of men receiving expectant management for low-risk prostate cancer is increasing. We conclude that growing awareness of the harms of overtreatment has profoundly affected trends for prostate cancer treatment in the USA.
AB - The management of prostate cancer (PCa) has evolved from a paradigm of "treat when caught early" to "treat only when necessary". Despite inconsistency in its use, active surveillance has evolved over the past two decades into the gold standard for management of low-risk PCa. Our objective was to investigate whether the use of expectant management (active surveillance, watchful waiting, no treatment) as a first-line approach for low-risk PCa has increased over the past decade. We queried the US National Cancer Data Base for men diagnosed with localized PCa between 2010 and 2020. Two multivariable logistic regression models with different two-way interaction terms (year of diagnosis × D'Amico risk classification, and year of diagnosis × International Society of Urological Pathology [ISUP] grade group) were fitted to predict the probability of undergoing expectant management versus active treatment. The predicted probability of expectant management increased from 13.7% in 2010 to 64.4% in 2020 for men with low-risk PCa, and from 12.9% in 2010 to 61.6% in 2020 for ISUP grade group 1 PCa (both pinteraction < 0.001). The frequency of expectant management for low-risk PCa has increased dramatically during the past decade. We expect this trend to further increase owing to the growing awareness of the harms of overtreatment of indolent disease. PATIENT SUMMARY: We examined the use of expectant management for prostate cancer between 2010 and 2020 in a large hospital-based registry from the USA. We found that the proportion of men receiving expectant management for low-risk prostate cancer is increasing. We conclude that growing awareness of the harms of overtreatment has profoundly affected trends for prostate cancer treatment in the USA.
U2 - 10.1016/j.eururo.2023.09.002
DO - 10.1016/j.eururo.2023.09.002
M3 - Short publication
C2 - 37758573
VL - 84
SP - 527
EP - 530
JO - EUR UROL
JF - EUR UROL
SN - 0302-2838
IS - 6
ER -