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Regional Variation in Active Surveillance for Low-Risk Prostate Cancer in the US
Samuel L Washington1,2, Chang Wook Jeong1,3, Peter E Lonergan1
1Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco.
JAMA Network Open
|December 28, 2020
Summary
Active surveillance (AS) for low-risk prostate cancer increased nationwide, but significant regional variations in its use were observed. Geographic location, not race or socioeconomic factors, was linked to these practice differences.
Area of Science:
- Urology
- Oncology
- Health Services Research
Background:
- Active surveillance (AS) is the preferred management for low-risk prostate cancer to avoid overtreatment.
- Despite its increasing use in the US, significant regional variability in AS adoption exists.
- These practice variations have not been well described across different geographic areas.
Purpose of the Study:
- To investigate variations in AS use between county and Surveillance, Epidemiology, and End Results (SEER) regions in the United States.
- To identify factors associated with the observed regional differences in AS adoption for prostate cancer.
Main Methods:
- A cohort study utilized the SEER Prostate with Watchful Waiting (WW) database linked to county-level demographic and physician data (2010-2015).
- Included were 79,825 men with clinically localized, low-risk prostate cancer eligible for AS or WW.
- Hierarchical mixed-effect logistic regression models assessed regional variation, and temporal trends were analyzed.
Main Results:
- Annualized AS rates increased from 2010-2015, with significant regional differences (e.g., 6.3% in New Mexico to 81.0% in New Jersey).
- SEER regions accounted for 17% of AS variation; increasing age correlated with higher AS odds.
- Hispanic ethnicity, T category, and Medicaid enrollment were associated with lower AS odds, while race, socioeconomic factors, and specialist density were not.
Conclusions:
- Active surveillance use increased in the US, but significant geographic practice variation persists.
- AS adoption was not associated with Black race, specialist density, or socioeconomic factors.
- Understanding these geographic variations is crucial for promoting risk-appropriate prostate cancer care nationwide.
