A hospital-based study of initial observation for low-risk prostate cancer and its predictors in the United States

Canadian Urological Association Journal = Journal De L'Association Des Urologues Du Canada
Matthew J MauriceRobert Abouassaly

Abstract

Initial observation (IO) is a strategy to minimize prostate cancer overtreatment. We sought to evaluate contemporary trends in IO utilization for low-risk prostate cancer in the United States and to identify factors associated with its uptake. Using the National Cancer Database, we identified men with low-risk prostate cancer diagnosed between 2004 and 2011. IO utilization was plotted over time. Multivariate logistic regression was performed to determine the influence of diagnosis year and other factors on IO selection. Of the 219 971 men with low-risk prostate cancer, 21 231 (9.7%) underwent IO. Beginning in 2008, IO use increased significantly with time (range: 7.5%-14.3%). Compared to 2004, patients diagnosed in 2011 had 2.5 times the odds of choosing IO (odds ratio [OR] 2.5, confidence interval [CI] 2.3-2.6, p < 0.01). Aside from diagnosis year, age, race, Charlson score, clinical T stage, and PSA level predicted IO use (p < 0.01). Other predictors of IO included hospital type, insurance provider, and household income. Specifically, comprehensive cancer centres, private insurance, and higher income predicted decreased IO usage (OR 0.5, CI 0.5-0.5, p < 0.01; OR 0.4, CI 0.4-0.4, p < 0.01; and OR 0.8, CI 0.8-0.9, p < 0.01, res...Continue Reading

Citations

Aug 21, 2015·Urology·Matthew J MauriceRobert Abouassaly
Jul 13, 2017·The New England Journal of Medicine·Timothy J WiltMichael K Brawer
Oct 22, 2019·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Richard M HoffmanKathryn Taylor

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