Overtreatment and Underutilization of Watchful Waiting in Men With Limited Life Expectancy: An Analysis of the Michigan Urological Surgery Improvement Collaborative Registry

被引:4
作者
Singhal, Udit [1 ,2 ,3 ,4 ,5 ,6 ,7 ]
Tosoian, Jeffrey J. [1 ,2 ,3 ,4 ,5 ,6 ,7 ]
Qi, Ji [1 ,2 ,3 ,4 ,5 ,6 ,7 ]
Miller, David C. [1 ,2 ,3 ,4 ,5 ,6 ,7 ]
Linsell, Susan M. [1 ,2 ,3 ,4 ,5 ,6 ,7 ]
Cher, Michael [1 ,2 ,3 ,4 ,5 ,6 ,7 ]
Lane, Brian [1 ,2 ,3 ,4 ,5 ,6 ,7 ]
Cotant, Michael [1 ,2 ,3 ,4 ,5 ,6 ,7 ]
Montie, James E. [1 ,2 ,3 ,4 ,5 ,6 ,7 ]
Bazzi, Wassim [1 ,2 ,3 ,4 ,5 ,6 ,7 ]
Jafri, Mohammad [1 ,2 ,3 ,4 ,5 ,6 ,7 ]
Rosenberg, Bradley [1 ,2 ,3 ,4 ,5 ,6 ,7 ]
George, Arvin K. [1 ,2 ,3 ,4 ,5 ,6 ,7 ]
机构
[1] Univ Michigan, Dept Urol, 1500 E Med Ctr Dr, Ann Arbor, MI 48103 USA
[2] Univ Michigan, Rogel Canc Ctr, Ann Arbor, MI 48103 USA
[3] Wayne State Univ, Dept Urol, Karmanos Canc Ctr, Detroit, MI USA
[4] Spectrum Hlth, Dept Urol, Grand Rapids, MI USA
[5] War Mem Hosp, Sault Ste Marie, MI USA
[6] Michigan Inst Urol, Troy, MI USA
[7] Comprehens Med Ctr, Dept Urol, Royal Oak, MI USA
关键词
QUALITY-OF-LIFE; PROSTATE-CANCER; ACTIVE-SURVEILLANCE; RADICAL PROSTATECTOMY; CONSERVATIVE MANAGEMENT; OUTCOMES;
D O I
10.1016/j.urology.2020.07.047
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE To determine rates of watchful waiting (WW) vs treatment in prostate cancer (PCa) and limited life expectancy (LE) and assess determinants of management. MATERIALS AND METHODS Patients diagnosed with PCa between 2012 and 2018 with <10 years LE were identified from the Michigan Urologic Surgery Improvement Collaborative registry. Multinomial logistic regression models were used to identify factors associated with management choice among NCCN low-risk PCa patients. Data from high-volume practices were analyzed to understand practice variation. RESULTS Total 2393 patients were included. Overall, WW was performed in 8.1% compared to 23.3%, 25%, 11.2%, and 3.6% who underwent AS, radiation (XRT), prostatectomy (RP), and brachytherapy (BT), respectively. In men with NCCN low-risk disease (n = 358), WW was performed in 15.1%, compared to AS (69.3%), XRT (4.2%), RP (6.7%), and BT (2.5%). There was wide variation in management among practices in low-risk men; WW (6%-35%), AS (44%-81%), and definitive treatment (0%-30%). Older age was associated with less likelihood of undergoing AS vs WW (odds ratio [OR] 0.88, P < .001) or treatment vs WW (OR 0.83, P < .0001). Presence of >= cT2 disease (OR 8.55, P = .014) and greater number of positive biopsy cores (OR 1.41, P = .014) was associated with greater likelihood of treatment vs WW and Charlson comorbidity score of 1 vs 0 (OR 0.23, P = .043) was associated with less likelihood of treatment vs WW. CONCLUSION Wide practice level variation exists in management for patients with low- and favorable-risk PCa and <10-year LE. Utilization of WW is poor, suggesting overtreatment in men who will experience little benefit. Published by Elsevier Inc.
引用
收藏
页码:190 / 195
页数:6
相关论文
共 29 条
[1]   20-year outcomes following conservative management of clinically localized prostate cancer [J].
Albertsen, PC ;
Hanley, JA ;
Fine, J .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2005, 293 (17) :2095-2101
[2]   Prostate Cancer Screening in the Randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: Mortality Results after 13 Years of Follow-up [J].
Andriole, Gerald L. ;
Crawford, E. David ;
Grubb, Robert L., III ;
Buys, Saundra S. ;
Chia, David ;
Church, Timothy R. ;
Fouad, Mona N. ;
Isaacs, Claudine ;
Kvale, Paul A. ;
Reding, Douglas J. ;
Weissfeld, Joel L. ;
Yokochi, Lance A. ;
O'Brien, Barbara ;
Ragard, Lawrence R. ;
Clapp, Jonathan D. ;
Rathmell, Joshua M. ;
Riley, Thomas L. ;
Hsing, Ann W. ;
Izmirlian, Grant ;
Pinsky, Paul F. ;
Kramer, Barnett S. ;
Miller, Anthony B. ;
Gohagan, John K. ;
Prorok, Philip C. .
JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2012, 104 (02) :125-132
[3]   A Roadmap for Improving the Management of Favorable Risk Prostate Cancer [J].
Auffenberg, Gregory B. ;
Lane, Brian R. ;
Linsell, Susan ;
Brachulis, Andrew ;
Ye, Zaojun ;
Rakic, Nikola ;
Montie, James ;
Miller, David C. ;
Cher, Michael L. .
JOURNAL OF UROLOGY, 2017, 198 (06) :1221-1223
[4]   Radical Prostatectomy or Watchful Waiting in Prostate Cancer-29-Year Follow-up [J].
Bill-Axelson, Anna ;
Holmberg, Lars ;
Garmo, Hans ;
Taari, Kimmo ;
Busch, Christer ;
Nordling, Stig ;
Haggman, Michael ;
Andersson, Swen-Olof ;
Andren, Ove ;
Steineck, Gunnar ;
Adami, Hans-Olov ;
Johansson, Jan-Erik .
NEW ENGLAND JOURNAL OF MEDICINE, 2018, 379 (24) :2319-2329
[5]   Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer [J].
Bill-Axelson, Anna ;
Holmberg, Lars ;
Garmo, Hans ;
Rider, Jennifer R. ;
Taari, Kimmo ;
Busch, Christer ;
Nordling, Stig ;
Haggman, Michael ;
Andersson, Swen-Olof ;
Spangberg, Anders ;
Andren, Ove ;
Palmgren, Juni ;
Steineck, Gunnar ;
Adami, Hans-Olov ;
Johansson, Jan-Erik .
NEW ENGLAND JOURNAL OF MEDICINE, 2014, 370 (10) :932-942
[6]   Appropriateness Criteria for Active Surveillance of Prostate Cancer [J].
Cher, Michael L. ;
Dhir, Apoorv ;
Auffenberg, Gregory B. ;
Linsell, Susan ;
Gao, Yuqing ;
Rosenberg, Bradley ;
Jafri, S. Mohammad ;
Klotz, Laurence ;
Miller, David C. ;
Ghani, Khurshid R. ;
Bernstein, Steven J. ;
Montie, James E. ;
Lane, Brian R. .
JOURNAL OF UROLOGY, 2017, 197 (01) :67-74
[7]   Comorbidity-Adjusted Life Expectancy: A New Tool to Inform Recommendations for Optimal Screening Strategies [J].
Cho, Hyunsoon ;
Klabunde, Carrie N. ;
Yabroff, K. Robin ;
Wang, Zhuoqiao ;
Meekins, Angela ;
Lansdorp-Vogelaar, Iris ;
Mariotto, Angela B. .
ANNALS OF INTERNAL MEDICINE, 2013, 159 (10) :667-+
[8]   RESULTS OF CONSERVATIVE MANAGEMENT OF CLINICALLY LOCALIZED PROSTATE-CANCER [J].
CHODAK, GW ;
THISTED, RA ;
GERBER, GS ;
JOHANSSON, JE ;
ADOLFSSON, J ;
JONES, GW ;
CHISHOLM, GD ;
MOSKOVITZ, B ;
LIVNE, PM ;
WARNER, J .
NEW ENGLAND JOURNAL OF MEDICINE, 1994, 330 (04) :242-248
[9]   Time Trends and Local Variation in Primary Treatment of Localized Prostate Cancer [J].
Cooperberg, Matthew R. ;
Broering, Jeanette M. ;
Carroll, Peter R. .
JOURNAL OF CLINICAL ONCOLOGY, 2010, 28 (07) :1117-1123
[10]   Cost Comparison Between Watchful Waiting With Active Surveillance and Active Treatment of Clinically Localized Prostate Cancer [J].
Corcoran, Anthony T. ;
Peele, Pamela B. ;
Benoit, Ronald M. .
UROLOGY, 2010, 76 (03) :703-707