Conservative management of low-risk prostate cancer among young versus older men in the United States: Trends and outcomes from a novel national database

Amandeep R. Mahal, Santino Butler, Idalid Franco, Vinayak Muralidhar, Dalia Larios, Luke R.G. Pike, Shuang G. Zhao, Nina N. Sanford, Robert T. Dess, Felix Y. Feng, Anthony V. D’Amico, Daniel E. Spratt, James B. Yu, Paul L. Nguyen, Timothy R. Rebbeck, Brandon A. Mahal

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background: Management for men aged ≤55 years with low-risk prostate cancer (LRPC) is debated given quality-of-life implications with definitive treatment versus the potential missed opportunity for cure with conservative management. The objective of this study was to define rates of conservative management for LRPC and associated short-term outcomes in young versus older men in the United States. Methods: The nonpublic Surveillance, Epidemiology, and End Results Prostate with Active Surveillance/Watchful Waiting (AS/WW) Database identified 50,302 men who were diagnosed with LRPC from 2010 through 2015. AS/WW rates in the United States were stratified by age (≤55 vs ≥56 years). Prostate cancer-specific mortality and overall mortality were defined by initial management type (AS/WW vs definitive treatment [referent]) and age. Results: AS/WW utilization increased from 8.61% (2010) to 34.56% (2015) among men aged ≤55 years (P for trend <0.001) and from 15.99% to 43.81% among men aged ≥56 years (P for trend <.001). Among patients who had ≤2 positive biopsy cores, AS/WW rates increased from 12.90% to 48.78% for men aged ≤55 years and from 21.85% to 58.01% for men aged ≥56 years. Among patients who had ≥3 positive biopsy cores, AS/WW rates increased from 3.89% to 22.45% for men aged ≤55 years and from 10.05% to 28.49% for men aged ≥56 years (all P for trend <.001). Five-year prostate cancer-specific mortality rates were <0.30% across age and initial management type subgroups. Conclusions: AS/WW rates quadrupled for patients aged ≤55 years from 2010 to 2015, with favorable short-term outcomes. These findings demonstrate the short-term safety and increasing acceptance of AS/WW for both younger and older patients. However, there are still higher absolute rates of AS/WW in older patients (P <.001), suggesting some national ambivalence toward AS/WW in younger patients.

Original languageEnglish (US)
Pages (from-to)3338-3346
Number of pages9
JournalCancer
Volume125
Issue number19
DOIs
Publication statusPublished - Oct 1 2019

    Fingerprint

Keywords

  • active surveillance
  • conservative treatment
  • low-risk prostate cancer
  • prostatic neoplasms
  • watchful waiting

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Mahal, A. R., Butler, S., Franco, I., Muralidhar, V., Larios, D., Pike, L. R. G., ... Mahal, B. A. (2019). Conservative management of low-risk prostate cancer among young versus older men in the United States: Trends and outcomes from a novel national database. Cancer, 125(19), 3338-3346. https://doi.org/10.1002/cncr.32332