Conservative management is becoming the most common approach for low-risk prostate cancer

The threefold increase in low risk men – from 14.5% in 2010 to 42.1% in 2015 – made it the most commonly used approach in this patient population.

"What we know from high-level evidence is that conservative management of low-risk prostate cancer is badociated with a very favorable prognosis," Brandon A. Mahal, MD, clinical researcher in radiation oncology at Dana-Farber / Brigham and Women's Cancer Center, said in a press release. "Many men with low-risk diseases can be spared the toxicity of treatment, so this is an important discussion between clinicians and patients."

Mahal and colleagues examined the SEER Prostate Active Surveillance Watchful Waiting database to identify 164,760 men (median age 64, 59 to 70 inter-quartile, 16.2% black) with localized cancer of the prostate. Prostate diagnosed between 2010 and 2015 and having a known treatment. strategy.

Of these men, 20,879 (12.7%) used active surveillance / watchful waiting; 68,350 (41.5%) received radiotherapy; and 75,531 (45.8%) underwent radical prostatectomy.

Compared to males diagnosed in 2010 (n = 31,355), males diagnosed in 2015 (n = 25,140) had significantly lower rates of low-risk disease (24.5% vs. 34.2%), and were more likely a higher median age (65 vs. 64). and higher median PSA concentration (6.7 ng / mL vs 6 ng / mL; P = 0.05 for all).

Among men with low-risk disease (n = 50,302), researchers observed an increase from 2010 to 2015 in the use of active surveillance / supervised waiting (from 14.5% to 42.1%) and decreased the use of radical prostatectomy (from 47.4% to 31.3%). ) and radiotherapy (38% to 26.6%; P <0.001 for the trend for all).

Men with intermediate-risk disease (n = 81,836) also experienced an increase in active surveillance / watchful waiting (from 5.8% to 9.6%). P <0.001 for the trend) and decrease in radical prostatectomy (51.8% to 50.6%, P = .004 for trend) and radiotherapy (42.4% to 39.8%, P <0.001 for the trend).

The use of active surveillance / watchful waiting remained constant in men with high-risk disease (n = 32,622, 1.9% to 2.2%), while the number of radical prostatectomies increased by 38% at 42.8% (P <0.001 for the trend) and the use of radiotherapy increased from 60.1% to 55% (P <0.001 for the trend).

"This shift in radiation therapy management models to a more radical prostatectomy is not supported by any recent high-level study," Mahal said. "This conclusion is provocative and may be a focus of the debate."

The lack of data on active monitoring / compliance with the monitored waiting period has limited this study.

"These results reflect the rapidly evolving landscape of localized prostate cancer management and suggest a" management migration "- in which radical radical prostatectomy is directed downwards in low-risk diseases (in the context of active surveillance / watchful waiting) may lead to a non-evidence-based management bias in favor of radical prostatectomy versus radiotherapy in a high-risk disease, "the researchers wrote. "These national trends are a tendency to target that should be addressed." – by Jennifer Byrne

References:

Butler S, et al. Summary 11. The presentation is intended for: Symposium on Genitourinary Cancer; February 14-16, 2019; San Francisco.

Mahal BA et al. JAMA. 2019; doi: 10,1001 / jama.201819941.

Disclosures: Mahal does not report any relevant disclosure. Please consult the study and the summary for the relevant financial information of all other authors.