The association of patient and disease characteristics with the overtreatment of low-risk prostate cancer from 2010...

Area of Science:

• Oncology
• Urology
• Health Services Research

Background:

• Active surveillance is preferred for low-risk prostate cancer (PCa), yet overtreatment with definitive therapy persists.
• Patient and disease characteristics may contribute to overtreatment and health disparities.

Purpose of the Study:

• To examine associations between patient/disease characteristics and surgical overtreatment of low-risk PCa.
• To identify factors contributing to the undertreatment of low-risk prostate cancer.

Main Methods:

• Analysis of 36,088 men (aged 45-75) with low-risk PCa (Gleason score 6, PSA <10) from the National Cancer Database (2010-2016).
• Men underwent radical prostatectomy (RP).
• Multivariable logistic regression evaluated associations with clinically insignificant PCa (iPCa) at RP, defined as organ-confined Gleason 3+3 disease.

Main Results:

• Overtreatment (iPCa) rates decreased from 54.7% (2010) to 40.0% (2016).
• Factors associated with lower overtreatment risk included older age, later diagnosis year, Black race, academic treatment centers, higher PSA, and more positive biopsy cores.
• More biopsy cores sampled was associated with increased overtreatment risk.

Conclusions:

• An approximate 27% reduction in low-risk PCa overtreatment was observed between 2010 and 2016.
• Patient, disease, and structural factors are linked to iPCa detection during RP.
• These findings can guide management to minimize overtreatment in low-risk PCa.