Presentation Authors: Kristina Vaculik, Vancouver, Canada, Michael Luu, Los Angeles, CA, Lauren Howard, Durham, NC, William Aronson, Los Angeles, CA, Martha Terris, Augusta, GA, Christopher Kane, San Diego, CA, Christopher Amling, Portland , OR, Matthew Cooperberg, San Francisco, CA, Stephen Freedland, Timothy Daskivich*, Los Angeles, CA
Introduction: Current prostate cancer (PC) treatment guidelines endorse active surveillance (AS) for most men with low-risk PC and select men with favorable intermediate-risk PC among those with â‰¥10-year life expectancy (LE), while recommending observation (or non-surgical management) for those with < 10-year LE. We sought to identify time trends in the use of radical prostatectomy (RP) for non-metastatic PC across subgroups of tumor risk and LE.
Methods: We sampled 4,902 men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database treated with radical prostatectomy for non-metastatic PC at 8 Veterans Affairs hospitals between 2000 and 2017. LE was calculated using age and Charlson comorbidity index scores. Stratified linear regression was used to calculate trends in proportion of men treated with RP by D&[prime]Amico tumor risk and LE (≥10 vs. < 10 years) subgroups.
Results: Across all men, from 2000 to 2017, the proportion of low-risk tumors treated with RP decreased from 51% to 8% (43% decrease, 95% CI -50% to -37%, p < 0.001), while the proportion of intermediate- and high-risk tumors increased from 32% to 60% (28% increase, 95% CI 24% to 32%, p < 0.001) and 17% to 33% (16% increase, 95% CI 9% to 23%, p=0.002), respectively. The proportion of favorable intermediate-risk tumors treated with RP decreased from 67% to 40% over the study period (27% decrease, 95% CI -47% to -6%, p=0.01). Among men older than 65 (n=1,398/4,902 (29%)), the proportion treated with RP did not differ over time between those with < 10-year LE (44% to 49%, 5% increase, 95% CI -4% to 14%, p=0.2) and those with â‰¥10-year LE (56% to 51%, 5% decrease, 95% CI -14% to 4%, p=0.2). There was also no statistically significant difference in proportion treated with RP over time between men with < 10 vs. â‰¥10-year LE within any tumor risk subgroup. However, the proportion treated with RP for favorable intermediate-risk disease appeared to decrease less markedly over time in men with < 10-year LE compared with â‰¥10-year LE (9% decrease vs. 44% decrease, p=0.07).
Conclusions: While VA urologists now are operating infrequently on low-risk tumors, rates of RP among men with limited LE appear to be stable over time. LE should play a greater role in triage and management of men with indolent PC.
Source of Funding: NCI K08CA230155