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The association of patient and disease characteristics with the overtreatment of low-risk prostate cancer from 2010 to 2016

Prostate Cancer and Prostatic Diseases (2024)Cite this article

Subjects

Abstract

Background

Although active surveillance is the preferred management for low-risk prostate cancer (PCa), some men remain at risk of overtreatment with definitive local therapy. We hypothesized that baseline characteristics may be associated with overtreatment and represent a potential source of health disparities. We therefore examined the associations of patient and disease characteristics with the surgical overtreatment of low-risk PCa.

Methods

We identified men aged 45–75 years with cT1 cN0 cM0 prostate adenocarcinoma with biopsy Gleason score 6 and PSA < 10 ng/ml from 2010–2016 in the National Cancer Database (NCDB) and who underwent radical prostatectomy (RP). We evaluated the associations of baseline characteristics with clinically insignificant PCa (iPCa) at RP (i.e., “overtreatment”), defined as organ-confined (i.e., pT2) Gleason 3 + 3 disease, using multivariable logistic regression.

Results

We identified 36,088 men with low-risk PCa who underwent RP. The unadjusted rate of iPCa decreased during the study period, from 54.7% in 2010 to 40.0% in 2016. In multivariable analyses adjusting for baseline characteristics, older age (OR 0.98, 95% CI 0.97–0.98), later year of diagnosis (OR 0.62, 95% CI 0.57–0.67 for 2016 vs. 2010), Black race (OR 0.85, 95% CI 0.79–0.91), treatment at an academic/research program (OR 0.82, 95% CI 0.73–0.91), higher PSA (OR 0.91, 95% CI 0.90–0.92), and higher number of positive biopsy cores (OR 0.87, 95% CI 0.86–0.88) were independently associated with a lower risk of overtreatment (iPCa) at RP. Conversely, a greater number of biopsy cores sampled (OR 1.01, 95% CI 1.01–1.02) was independently associated with an increased risk of overtreatment (iPCa) at RP.

Conclusions

We observed an ~27% reduction in rates of overtreatment of men with low-risk PCa over the study period. Several patient, disease, and structural characteristics are associated with detection of iPCa at RP and can inform the management of men with low-risk PCa to reduce potential overtreatment.

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Data availability

The data that support the findings of this study are available from American College of Surgeons through a data request.

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Author information

Authors and Affiliations

  1. Williams College, Williamstown, MA, USA

    Cooper Desmond

  2. Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Sumedh Kaul & Aaron Fleishman

  3. Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Ruslan Korets, Peter Chang, Andrew Wagner, Aria F. Olumi & Boris Gershman

  4. Division of Urology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

    Simon P. Kim

  5. Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Nima Aghdam

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Contributions

Desmond: study conception/design, interpretation of statistical analyses, manuscript preparation/revision. Kaul: study conception/design, conducting statistical analyses, manuscript preparation/revision. Fleishman: study conception/design, manuscript revision. Korets: study conception/design, manuscript revision. Chang: study conception/design, manuscript revision. Wagner: study conception/design, manuscript revision. Kim: study conception/design, manuscript revision. Aghdam: study conception/design, manuscript revision. Olumi: study conception/design, manuscript revision. Gershman: study conception/design, interpretation of statistical analyses, manuscript preparation/revision, supervision.

Corresponding author

Correspondence to Boris Gershman.

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Competing interests

The authors declare no competing interests. The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Desmond, C., Kaul, S., Fleishman, A. et al. The association of patient and disease characteristics with the overtreatment of low-risk prostate cancer from 2010 to 2016. Prostate Cancer Prostatic Dis (2024). https://doi.org/10.1038/s41391-024-00822-2

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