Time trends and characteristics of men choosing watchful waiting for initial treatment of localized prostate cancer: results from CaPSURE.
OBJECTIVE
Watchful waiting (WW) is one option for men with clinically localized prostate cancer. We examined temporal trends in the use of WW, as well as sociodemographic and clinical profiles of men who choose this form of management.


METHODS
The Cancer of the Prostate Strategic Urologic Research Endeavor is a national registry of patients with various stages of prostate cancer. Between 1989 and 2000, 5,365 men in the database were diagnosed with localized disease and elected either WW or active treatment within 9 months of diagnosis. Of these men 402 elected WW as initial disease management. We analyzed time trends in WW use, and sociodemographic and clinical predictors of WW using chi-square tests and multivariate logistical regression.


RESULTS
In examining 3-year intervals, use of WW increased from 7.5% in 1989 to 1991 to 9.5% in 1992 to 1994, and then decreased during the next 6 years to 5.5% in 1998 to 2000 (p = 0.001). With time there was a significant increase in the proportion of WW patients with T1 disease and prostate specific antigen of 10 ng/ml or less. Compared to patients choosing active treatment, patients opting for WW were more likely to have low risk disease. After controlling for clinical factors WW patients were also more likely to be 75 years old or older, to have Medicare insurance and to have greater comorbidity.


CONCLUSIONS
During the prostate specific antigen era rates of WW for the initial treatment of prostate cancer have been decreasing despite considerable downward stage migration. We expect that as prostate cancer risk assessment and surveillance strategies continue to improve, more patients may benefit from this approach to management.
Harlan
Susan R
SR
Department of Urology, Program in Urologic Oncology, Urologic Outcomes Research Group, UCSF/Mt. Zion Comprehensive Cancer Center, University of California-San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
Cooperberg
Matthew R
MR
Elkin
Eric  P
E
Lubeck
Deborah P
DP
Meng
Maxwell  V
M
Mehta
Shilpa S
SS
Carroll
Peter R
PR
D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D016009:Chi-Square Distribution; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D009367:Neoplasm Staging; D019370:Observation; D010358:Patient Participation / Q000639:trends*; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D012042:Registries; D018570:Risk Assessment; D012959:Socioeconomic Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen