After a history of over treatment of low-risk prostate cancer, a new study demonstrates an increase in watchful waiting and active surveillance, as well as appropriate local treatment for high-risk prostate cancer.1
“A number of studies over the years, from our group and others, have documented consistent over treatment of low-risk prostate cancer—that is, use of surgery, radiation, and other treatments for tumors that would never cause any symptoms or loss of life expectancy had they never been diagnosed,” Matthew R. Cooperberg, MD, MPH, of the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, told Cancer Therapy Advisor.
Studies involving data from academic centers demonstrate the safety of active surveillance with a diagnosis of low-risk prostate cancer. However, current treatment patterns of prostate cancer in community-based practices have not been well established.
In a research letter published in JAMA, Dr. Cooperberg and Peter R. Carroll, MD, MPH, also of the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, presented their study results.
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Data on men with prostate cancer since 1995 was obtained from small and large urology practices in 28 states from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE). Enrollment was prospective from 1998 but was both retrospective and prospective prior to 1998.
The study participants were men with prostate tumors of stage cT3aN0M0 or lower who were treated between 1990 and 2013 with radiation, prostatectomy, monotherapy androgen deprivation, or watchful waiting/active surveillance.
The Cancer of the Prostate Risk Assessment (CAPRA) score was used to stratify the cancer risk. In men age 75-years or older, treatment trends were analyzed in 5-year intervals.
With a mean age of 65.7 years (SD of 8.8 years) and median CAPRA score of 2 (range of 1 to 4), 10,472 men were included in the study. Of the participants, 87% (9,111 patients) were white and 9.7% (1,015 patients) were black.
From 1990 through 2009, active surveillance was low for low-risk prostate cancer (CAPRA score 0 to 2) and varied from 6.7% (95% CI, 5.8%-7.6%) to 14.3% (95% CI, 10.3%-18.3%). However, there was a noticeable increase to 40.4% in 2010 through 2013 (95% CI, 34.9%-45.9%, P<0.001 for trend).