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United States trends in active surveillance or watchful waiting across patient socioeconomic status from 2010 to 2015

Prostate Cancer and Prostatic Diseases volume 23, pages 179–183 (2020)Cite this article

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Abstract

Background

Prospective evidence supports active surveillance/watchful waiting (AS/WW) as an efficacious management option for low-risk prostate cancer that avoids potential treatment toxicity. AS/WW schedules require regular follow-up and adherence, and it is unknown to what extent patient socioeconomic status (SES) may impact management decisions for AS/WW. We sought to determine whether AS/WW use in the United States differs according to patient SES.

Design

Using the Surveillance, Epidemiology, and End Results Prostate with AS/WW Database, all adult men diagnosed with localized low-risk prostate cancer (clinical T1–T2a, Gleason 6, and prostate-specific antigen <10 ng/mL) and managed with either AS/WW, radical prostatectomy, or radiotherapy were identified between 2010 and 2015. SES tertile was measured by the validated Yost Index (low: 0–10,901; middle: 10,904–11,469; high: 11,470–11,827). AS/WW trends were defined across SES tertiles from 2010 to 2015. Logistic multivariable regression defined adjusted odds ratios (aOR) for receipt of AS/WW by SES tertile.

Results

In 50,302 men, AS/WW use was higher with increasing SES tertile (24.6, 25.3, and 30.5% for low, middle, and high SES tertiles, respectively; PTrend (SES) <0.001). From 2010 to 2015, AS/WW use in the low, middle, and high SES tertiles increased from 11.2 to 37.3%, 14.1 to 45.8%, and 17.6 to 46.4%, respectively (PTrends <0.001). By 2015, likelihood of AS/WW became comparable among the middle vs. high SES tertiles (aOR 0.96, 95% confidence interval (CI): 0.83–1.11, P = 0.55), but remained lower among the low vs. high SES tertile (aOR 0.73, 95% CI: 0.64–0.83, P < 0.001).

Conclusions

AS/WW use for low-risk prostate cancer in the US differs by SES. Despite increases in AS/WW across SES from 2010 to 2015, patients from low SES received significantly lower rates of AS/WW compared with higher SES groups. SES may therefore influence management decisions, where factors associated with low SES might act as a barrier to AS/WW, and may need to be addressed to reduce any disproportionate risk of unnecessary treatment to lower SES patients.

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Acknowledgements

Dr. Mahal is funded by the Prostate Cancer Foundation-American Society for Radiation Oncology Award to End Prostate Cancer. Dr. Nguyen is funded by the Prostate Cancer Foundation. None of the funders listed above had any input on the design and conduct of the study; None of the funders listed above had any input on the collection, management, analysis, and interpretation of the data; None of the funders listed above had any input on the preparation, review, or approval of the manuscript; None of the funders listed above had any input on the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Santino S. Butler, Cierra Zaslowe-Dude, Vinayak Muralidhar, Daniel W. Kim, Paul L. Nguyen & Brandon A. Mahal

  2. Department of Urology and Population Health, New York University and Manhattan VA, New York, NY, USA

    Stacy Loeb

  3. Division of Urological Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Alexander P. Cole & Quoc-Dien Trinh

  4. Department of Urology and Polsky Urologic Cancer Institute, Northwestern University, Chicago, IL, USA

    Edward M. Schaeffer

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  1. Santino S. Butler
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Correspondence to Brandon A. Mahal.

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Butler, S.S., Loeb, S., Cole, A.P. et al. United States trends in active surveillance or watchful waiting across patient socioeconomic status from 2010 to 2015. Prostate Cancer Prostatic Dis 23, 179–183 (2020). https://doi.org/10.1038/s41391-019-0175-9

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