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Updated: Apr 7, 2026
Microarray-based Identification of Individual HERV Loci Expression: Application to Biomarker Discovery in Prostate Cancer
Published on: November 2, 2013
Population-Based Assessment of Determining Treatments for Prostate Cancer
Karim Chamie1, Stephen B Williams2, Jim C Hu1
1Department of Urology, David Geffen School of Medicine at University of California, Los Angeles.
Importance:
Many men with indolent prostate cancer often opt for radical prostatectomy or radiotherapy treatment for their disease. These men may experience considerable detriments of quality of life owing to sexual, urinary, and/or rectal toxic effects associated with these treatments. Without a better understanding of the mutable agents and predictors of treatment types, diffusion of expectant management among these men will be slow.
Objective:
To determine population-based predictors for treatment and use of watchful waiting or active surveillance for indolent prostate cancer.
Design, Setting, And Participants:
We used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. A total of 37,621 men in the general community diagnosed as having prostate cancer from 2004 to 2007 were followed until December 31, 2009.
Exposures:
Watchful waiting or active surveillance, radiation therapy, or radical prostatectomy.
Main Outcomes And Measures:
We used mixed-effects logistic regression analysis to determine the factors associated with aggressive treatment and use of watchful waiting or active surveillance for men with prostate cancer.
Results:
The most common treatment type is radiation therapy (57.9% [95% CI, 57.4%-58.4%]), followed by radical prostatectomy (19.1% [95% CI, 18.7%-19.5%]) and watchful waiting or active surveillance (9.6% [95% CI, 9.3%-9.9%]). Moreover, patients and providers significantly integrate age (odds ratio [OR], 0.32 [95% CI, 0.29-0.35]) and comorbidities (OR, 0.62 [95% CI, 0.56-0.68]) when determining radical prostatectomy, while regional variation (OR, 0.57 [95% CI, 0.47-0.68]) and referral patterns (OR, 44.46 [95% CI, 41.04-48.17]) influence the use of radiation therapy. Patient demographics and tumor characteristics significantly account for 40% of patients undergoing prostatectomy, 12% choosing watchful waiting or active surveillance, and only 3% undergoing radiotherapy.
Conclusions And Relevance:
There is increased use of radiotherapy among patients with indolent prostate cancer with limited to no correlation with tumor biology. Active surveillance was underused, and a significant proportion of the variance was unexplained. Further research into qualitatively describing the contributing factors that drive decision-making recommendations for prostate cancer patients is needed.
Insights
Watchful waiting or active surveillance is underused for indolent prostate cancer. Treatment decisions for prostate cancer often overlook tumor biology, leading to suboptimal radiotherapy use.
Area of Science:
- Oncology
- Urology
- Public Health
Background:
- Indolent prostate cancer management often involves radical prostatectomy or radiotherapy, leading to significant quality-of-life detriments.
- Understanding predictors of treatment selection is crucial for improving patient outcomes and promoting expectant management strategies.
Purpose of the Study:
- To identify population-based predictors influencing treatment choices for indolent prostate cancer.
- To assess the utilization of watchful waiting or active surveillance versus aggressive treatments.
Main Methods:
- Utilized Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data for 37,621 men diagnosed with prostate cancer (2004-2007).
- Employed mixed-effects logistic regression to analyze factors associated with treatment selection (watchful waiting/active surveillance, radiation therapy, radical prostatectomy).
Main Results:
- Radiation therapy was the most common treatment (57.9%), followed by radical prostatectomy (19.1%), and watchful waiting/active surveillance (9.6%).
- Age and comorbidities influenced radical prostatectomy decisions, while regional variation and referral patterns impacted radiation therapy use.
- Patient demographics and tumor characteristics explained only a small proportion of treatment decisions, particularly for radiotherapy (3%).
Conclusions:
- Radiotherapy is frequently used for indolent prostate cancer with minimal correlation to tumor biology.
- Active surveillance is underutilized, and significant unexplained variance exists in treatment decision-making.
- Further qualitative research is needed to understand the factors driving treatment recommendations for prostate cancer patients.
