title: Regional, provider, and economic factors associated with the choice of active surveillance in the treatment of men with localized prostate cancer.
abstract: Data on initial treatment of 8232 cases of localized prostate cancer diagnosed in 2004 were obtained by medical record abstraction (including hospital and outpatient locations) from seven state cancer registries participating in the Centers for Disease Control and Prevention's Breast and Prostate Cancer Data Quality and Patterns of Care Study. Distinction was made between men receiving no therapy with no monitoring plan (no therapy/no plan [NT/NP]) and those receiving active surveillance (AS). Overall, 8.6% received NT/NP and 4.7% received AS. Older age at diagnosis, lower clinical risk group, and certain registry locations were significant predictors of use of both AS and NT/NP. AS was also related to having more severe comorbidities, whereas nonwhite race was predicted receiving NT/NP. Men receiving AS lived in areas with a higher number of urologists per 100 000 men than those receiving NT/NP. In summary, physician and clinical factors were stronger predictors of AS, whereas demographic and regional factors were related to receiving NT/NP. Physicians appear reluctant to recommend AS for younger patients with no comorbidities.
authors.affiliation: Keck School of Medicine of University of Southern California, 2001 N. Soto St 318E, Los Angeles, CA 90089-9239, USA. ahamilt@med.usc.edu
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.forename: Xiao-Cheng
authors.initials: XC
authors.lastname: Wu
authors.forename: Joseph
authors.initials: J
authors.lastname: Lipscomb
authors.forename: Steven T
authors.initials: ST
authors.lastname: Fleming
authors.forename: Mary
authors.initials: M
authors.lastname: Lo
authors.forename: Dian
authors.initials: D
authors.lastname: Wang
authors.forename: Michael
authors.initials: M
authors.lastname: Goodman
authors.forename: Alex
authors.initials: A
authors.lastname: Ho
authors.forename: Jean B
authors.initials: JB
authors.lastname: Owen
authors.forename: Chandrika
authors.initials: C
authors.lastname: Rao
authors.forename: Robert R
authors.initials: RR
authors.lastname: German
mesh_terms: D000368:Aged; D002755:Choice Behavior; D003657:Decision Making; D003661:Decision Support Techniques; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000601:surgery / Q000628:therapy; D012944:Social Support; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen