Use of Active Surveillance or Watchful Waiting for Low-Risk Prostate Cancer and Management Trends Across Risk Groups in the United States, 2010-2015
Menée à partir des données des registres américains des cancers, cette étude analyse l'évolution des traitements et l'utilisation de la surveillance active chez des patients atteints d'un cancer localisé de la prostate à faible risque de récidive et diagnostiqué entre 2010 et 2015
Historically, most patients with low-risk prostate cancer (clinical category T1c-T2a, prostate-specific antigen level <10 ng/mL, and Gleason 6 disease) were treated with radical prostatectomy, while radiotherapy-based treatment was the favored approach for high-risk localized prostate cancer.1 However, conservative management of low-risk prostate cancer with active surveillance or watchful waiting (AS/WW) offers an alternative to radical prostatectomy or radiotherapy,2 and national guidelines began advocating its use in 2010.3,4 Nevertheless, current AS/WW rates across the United States are not well established, and it is unclear if increasing acceptance of AS/WW for low-risk prostate cancer might be associated with changes in management patterns in higher-risk prostate cancer. Therefore, we examined US trends in management patterns for localized prostate cancer across risk groups. Methods : The custom Surveillance, Epidemiology, and End Results (SEER) Prostate Active Surveillance/Watchful Waiting database, unlike other databases, includes a quality-assured AS/WW variable.5 The proposal for this study was approved by the SEER custom data group. All men with localized prostate cancer diagnosed between 2010 and 2015 and known management type were included. Patients designated by treating facilities as receiving AS or WW as management without any receipt of definitive therapy were coded by SEER as AS/WW.5 If changes from AS/WW to definitive therapy occurred within 1 year of diagnosis for reasons other than disease progression, the cases were coded as the definitive therapy used. Definitive therapy types were defined by SEER as either definitive radical prostatectomy or radiotherapy (including external-beam radiotherapy, brachytherapy, or any combination thereof); the positive predictive value and specificity of both variables are high. Baseline characteristics, stratified by year of diagnosis, were summarized by descriptive statistics. Use of initial management or therapy type (AS/WW, radical prostatectomy, or radiotherapy), stratified by National Comprehensive Cancer Network risk category (low, intermediate, or high),3 was determined from 2010 to 2015, with the Cochran-Armitage test used to test for trends. (...)
JAMA 2019