Cooper Desmond, Sumedh Kaul, Aaron Fleishman, Ruslan Korets, Peter Chang, Andrew Wagner, Simon P Kim, Nima Aghdam, Aria F Olumi, Boris Gershman
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We evaluated the associations of baseline characteristics with clinically insignificant PCa (iPCa) at RP (i.e., \"overtreatment\"), defined as organ-confined (i.e., pT2) Gleason 3 + 3 disease, using multivariable logistic regression.</p><p><strong>Results: </strong>We identified 36,088 men with low-risk PCa who underwent RP. The unadjusted rate of iPCa decreased during the study period, from 54.7% in 2010 to 40.0% in 2016. In multivariable analyses adjusting for baseline characteristics, older age (OR 0.98, 95% CI 0.97-0.98), later year of diagnosis (OR 0.62, 95% CI 0.57-0.67 for 2016 vs. 2010), Black race (OR 0.85, 95% CI 0.79-0.91), treatment at an academic/research program (OR 0.82, 95% CI 0.73-0.91), higher PSA (OR 0.91, 95% CI 0.90-0.92), and higher number of positive biopsy cores (OR 0.87, 95% CI 0.86-0.88) were independently associated with a lower risk of overtreatment (iPCa) at RP. 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Several patient, disease, and structural characteristics are associated with detection of iPCa at RP and can inform the management of men with low-risk PCa to reduce potential overtreatment.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":null,"pages":null},"PeriodicalIF":5.1000,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The association of patient and disease characteristics with the overtreatment of low-risk prostate cancer from 2010 to 2016.\",\"authors\":\"Cooper Desmond, Sumedh Kaul, Aaron Fleishman, Ruslan Korets, Peter Chang, Andrew Wagner, Simon P Kim, Nima Aghdam, Aria F Olumi, Boris Gershman\",\"doi\":\"10.1038/s41391-024-00822-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Although active surveillance is the preferred management for low-risk prostate cancer (PCa), some men remain at risk of overtreatment with definitive local therapy. 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In multivariable analyses adjusting for baseline characteristics, older age (OR 0.98, 95% CI 0.97-0.98), later year of diagnosis (OR 0.62, 95% CI 0.57-0.67 for 2016 vs. 2010), Black race (OR 0.85, 95% CI 0.79-0.91), treatment at an academic/research program (OR 0.82, 95% CI 0.73-0.91), higher PSA (OR 0.91, 95% CI 0.90-0.92), and higher number of positive biopsy cores (OR 0.87, 95% CI 0.86-0.88) were independently associated with a lower risk of overtreatment (iPCa) at RP. Conversely, a greater number of biopsy cores sampled (OR 1.01, 95% CI 1.01-1.02) was independently associated with an increased risk of overtreatment (iPCa) at RP.</p><p><strong>Conclusions: </strong>We observed an ~27% reduction in rates of overtreatment of men with low-risk PCa over the study period. 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引用次数: 0
摘要
背景:尽管积极监测是低风险前列腺癌(PCa)的首选治疗方法,但一些男性仍面临着接受确定性局部治疗后过度治疗的风险。我们假设基线特征可能与过度治疗有关,并且是健康差异的潜在来源。因此,我们研究了患者和疾病特征与低风险 PCa 手术过度治疗的关系:我们确定了 45-75 岁患有 cT1 cN0 cM0 前列腺腺癌、活检 Gleason 评分 6 分和 PSA 结果的男性:我们发现了 36088 名接受了前列腺癌根治术的低危 PCa 患者。在研究期间,未经调整的 iPCa 发生率从 2010 年的 54.7% 降至 2016 年的 40.0%。在调整基线特征的多变量分析中,年龄较大(OR 0.98,95% CI 0.97-0.98)、诊断年份较晚(2016 年与 2010 年相比,OR 0.62,95% CI 0.57-0.67)、黑人种族(OR 0.85,95% CI 0.79-0.91)、在学术/研究项目中接受治疗(OR 0.82,95% CI 0.73-0.91)、较高的 PSA(OR 0.91,95% CI 0.90-0.92)和较多的阳性活检核(OR 0.87,95% CI 0.86-0.88)与 RP 时较低的过度治疗(iPCa)风险独立相关。相反,取样活检核的数量越多(OR 1.01,95% CI 1.01-1.02),RP时过度治疗(iPCa)的风险就越高:我们观察到,在研究期间,低风险男性 PCa 患者的过度治疗率降低了约 27%。一些患者、疾病和结构特征与RP时发现iPCa有关,可为低风险PCa男性患者的管理提供参考,以减少潜在的过度治疗。
The association of patient and disease characteristics with the overtreatment of low-risk prostate cancer from 2010 to 2016.
Background: Although active surveillance is the preferred management for low-risk prostate cancer (PCa), some men remain at risk of overtreatment with definitive local therapy. We hypothesized that baseline characteristics may be associated with overtreatment and represent a potential source of health disparities. We therefore examined the associations of patient and disease characteristics with the surgical overtreatment of low-risk PCa.
Methods: We identified men aged 45-75 years with cT1 cN0 cM0 prostate adenocarcinoma with biopsy Gleason score 6 and PSA < 10 ng/ml from 2010-2016 in the National Cancer Database (NCDB) and who underwent radical prostatectomy (RP). We evaluated the associations of baseline characteristics with clinically insignificant PCa (iPCa) at RP (i.e., "overtreatment"), defined as organ-confined (i.e., pT2) Gleason 3 + 3 disease, using multivariable logistic regression.
Results: We identified 36,088 men with low-risk PCa who underwent RP. The unadjusted rate of iPCa decreased during the study period, from 54.7% in 2010 to 40.0% in 2016. In multivariable analyses adjusting for baseline characteristics, older age (OR 0.98, 95% CI 0.97-0.98), later year of diagnosis (OR 0.62, 95% CI 0.57-0.67 for 2016 vs. 2010), Black race (OR 0.85, 95% CI 0.79-0.91), treatment at an academic/research program (OR 0.82, 95% CI 0.73-0.91), higher PSA (OR 0.91, 95% CI 0.90-0.92), and higher number of positive biopsy cores (OR 0.87, 95% CI 0.86-0.88) were independently associated with a lower risk of overtreatment (iPCa) at RP. Conversely, a greater number of biopsy cores sampled (OR 1.01, 95% CI 1.01-1.02) was independently associated with an increased risk of overtreatment (iPCa) at RP.
Conclusions: We observed an ~27% reduction in rates of overtreatment of men with low-risk PCa over the study period. Several patient, disease, and structural characteristics are associated with detection of iPCa at RP and can inform the management of men with low-risk PCa to reduce potential overtreatment.
期刊介绍:
Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management.
Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis.
Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.