Prostate Cancer Expectant Management On the Rise

Matthew J. Maurice, MD
Matthew J. Maurice, MD

SAN FRANCISCO—Expectant management (EM) for low-risk prostate cancer (PCa), which includes active surveillance and watchful waiting, is on the upswing, particularly among older patients and those with multiple co-morbidities, researchers reported at the 2014 Genitourinary Cancers Symposium.

Matthew J. Maurice, MD, a urology resident at University Hospitals Case Medical Center in Cleveland, and colleagues used the National Cancer Database—a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society—to identify 287,562 men diagnosed with low-risk PCa from 2004 to 2011. Of these, 34,132 received EM.

The investigators observed a significant and steady rise in EM usage beginning in 2008. Compared with patients diagnosed in 2004, those diagnosed in 2011 had a significant 2.5 times increased odds of receiving EM, the study found. Aside from year of diagnosis, older age and higher Charlson co-morbidity scores predicted increased use of EM usage.

Hospital and insurance types also predicted EM use, “calling into question whether non-clinical factors are influencing EM selection,” the authors concluded in a poster presentation. Patients treated at comprehensive cancer centers had a significant 37% decreased likelihood of receiving EM than patients treated at community hospitals. Patients with private health insurance had a significant 10% decreased odds of receiving EM compared with those who had publicly funded health coverage.

“It is possible that patients who seek care at comprehensive cancer centers or who have private health insurance are more involved in making decisions about their own medical care,” Dr. Maurice told Renal & Urology News. The study could not address this because of limitations of the National Cancer Database, he said.

Moreover, there may be financial disincentives for healthcare systems or healthcare providers to offer EM, as this approach is known to cost less—and presumably, reimburse less—than initial active treatment over a wide range of clinical scenarios, he said.

The symposium is co-sponsored by the American Society of Clinical Oncology, the American Society for Radiation Oncology, and the Society of Urologic Oncology.

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