Abstract
Background
Concurrent with the decrease in the number of men diagnosed with prostate cancer (PCa), the proportion of men with low-risk PCa managed conservatively (active surveillance or watchful waiting) has increased in the United States. We aimed to determine whether this increase is a result of more men being managed conservatively or rather a higher proportion of the diminishing number of low-risk PCa managed this way.
Methods
The SEER “Prostate Watchful Waiting Database” identified men managed initially with conservative management between 2010 and 2016. Men > 40 years old who were diagnosed with low-risk (Gleason score 3 + 3, T1–T2a, PSA level < 10 ng/mL) PCa were included. Age-standardized and age-specific PCa incidence and conservative management rates were calculated per 100,000 man-years. The annual percent change in rates for the entire time period was also calculated.
Results
The incidence of low-risk PCa declined by 11.8% per year (95% confidence interval [CI] −15.4% to −8.0%), whereas the number of men assigned to conservative management for low-risk disease did not increase significantly, rising by +3.7% per year (95% CI −0.7% to 8.4%). In age-specific analysis, the number of men < 60 years and those who were 60–69 years managed conservatively increased by +9.6% per year (95% CI 2.7% to 16.9%) and 4.5% per year (95% CI 0.1% to 9.1%), respectively, whereas the number of men ≥ 70 years electing conservative management remained stable at −4% per year (95% CI −11.2% to 3.7%).
Conclusions
The number of men electing conservative management has remained largely stable between 2010 and 2016, despite an increase in the proportion of low-risk PCa managed in this manner.
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Funding
JS and JCH are supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. JS is supported by the Damon Runyon Cancer Research Foundation Physician Scientist Training Award.
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Al Hussein Al Awamlh, B., Ballman, K.V., Ma, X. et al. Temporal trends in the number of men electing for conservative management for low-risk prostate cancer in the United States. Prostate Cancer Prostatic Dis 23, 714–717 (2020). https://doi.org/10.1038/s41391-020-0252-0
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DOI: https://doi.org/10.1038/s41391-020-0252-0
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