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Clinical Research

Temporal trends in the number of men electing for conservative management for low-risk prostate cancer in the United States

Prostate Cancer and Prostatic Diseases volume 23, pages 714–717 (2020)Cite this article

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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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Fig. 1: Temporal trends in age-standardized rates of low-risk (Gleason score 3 + 3, T1–T2a, prostate specific-antigen < 10 ng/mL) prostate cancer and conservative management for low-risk prostate cancer.

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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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Authors and Affiliations

  1. Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA

    Bashir Al Hussein Al Awamlh, Jim C. Hu & Jonathan E. Shoag

  2. Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA

    Karla V. Ballman & Xiaoyue Ma

  3. University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA

    Jonathan E. Shoag

  4. Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Jonathan E. Shoag

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  1. Bashir Al Hussein Al Awamlh
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Correspondence to Jonathan E. Shoag.

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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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