Genitourinary Cancer

PV 04 - Poster Viewing Q&A - Session 4

TU_24_2602 - Trends in Active Surveillance/Watchful Waiting in Low and Favorable Intermediate Risk Prostate Cancer before and after the 2012 USPSTF Recommendations Against PSA Screening.

Tuesday, September 17
2:45 PM - 4:00 PM
Location: ASTRO Innovation Hub

Trends in Active Surveillance/Watchful Waiting in Low and Favorable Intermediate Risk Prostate Cancer before and after the 2012 USPSTF Recommendations Against PSA Screening.
K. S. Aujla1, K. C. Bylund1, M. A. Cummings2, and M. T. Milano1; 1Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, 2University of Rochester Medical Center, Rochester, NY

Purpose/Objective(s): To investigate changes in the initial treatment management of low and favorable intermediate risk prostate cancer, before and after the 2012 United States Preventative Service Task Force (USPSTF) recommending against the routine use of PSA screening. Materials/Methods: Patients with AJCC Stage I and IIA prostate cancer registered to the Surveillance, Epidemiology, and End Result program’s specialized ‘Prostate with Watchful Waiting Database’ were identified from the years 2010-2015. Patients were included for analysis if they had a record of treatment with either surgery, external beam radiation (EB), or brachytherapy (BT), or were identified as active surveillance/watchful waiting (AS/WW) (SEER does not differentiate between the two). Only Favorable Intermediate Risk Patients were included - Stage IIA patients were excluded if they had more than one intermediate risk factor (≥T2b, PSA ≥10, GS=7), ≥50% positive cores, or a GS of 4+3. Age, race, , insurance, marital status, year of diagnosis, , and prior cancers were also assessed. Descriptive statistics, odds ratio, and chi-squared testing were performed using STATA software.

Results: Of 78,663 evaluable patients, 58,988 (75%) had low risk disease and 19,675 (25%) had favorable intermediate risk disease. There were 263 deaths from prostate cancer, with 53, 108, 95, and 33 in the AS/WW, surgery, EB, and BT groups, respectively. The annual incidence of prostate cancer dropped from 15,234 in 2010 to 10,750 in 2015. Overall 28.3%, 29.1%, 26.4% and 16.2% of patients underwent AS/WW, surgery, EB, and BT, respectively. The overall rate of AS/WW for men age < 55, 55-69, and ≥ 70 was 30.0%, 30.1%, and 25.5% respectively. The annual rate of patients undergoing AS/WW increased from 19.6% in 2010 to 38.4% in 2015 (p<0.001). The rate of AS/WW for 2010-2012 vs. 2013-2015 increased from 23.2% to 36.8% (p<0.001). Year of diagnosis, low risk vs. favorable intermediate risk prostate cancer, being unmarried vs. married, Caucasian vs. African American race, and age < 69 vs. ≥ 70 were all strongly associated (p<0.001) with a patient undergoing AS/WW.

Conclusion: Consistent with national trends, data from the SEER program show a dramatic decline in incidence of low and favorable-intermediate risk prostate cancer from 2010-2015. In contrast, the rate of patients undergoing AS/WW as a first decision for treatment management for prostate cancer has significantly increased. The trend of selecting AS/WW instead of treatment for prostate cancer, despite dropping overall incidence, highlights the abilities of physicians to engage in shared decision making for treatment. This study validates new USPSTF guidelines that men (specifically age 55-69) should have the option to discuss PSA screening with their providers.

Author Disclosure: K.S. Aujla: None. K.C. Bylund: None. M.A. Cummings: None. M.T. Milano: Honoraria; UpToDate.

Send Email for Khush Aujla


Assets

TU_24_2602 - Trends in Active Surveillance/Watchful Waiting in Low and Favorable Intermediate Risk Prostate Cancer before and after the 2012 USPSTF Recommendations Against PSA Screening.



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for Trends in Active Surveillance/Watchful Waiting in Low and Favorable Intermediate Risk Prostate Cancer before and after the 2012 USPSTF Recommendations Against PSA Screening.