title: National trends in the management of low and intermediate risk prostate cancer in the United States.
abstract: OBJECTIVE
  To our knowledge factors affecting the adoption of noncurative initial management in the United States for low risk prostate cancer on a population based level are unknown. We measured temporal trends in the proportion of patients with low and intermediate risk prostate cancer who elected noncurative initial treatment in the United States and analyzed the association of factors affecting management choice.
  
  
  METHODS
  We identified 465,591 and 237,257 men diagnosed with low or intermediate risk prostate cancer using NCDB and SEER (2004 to 2010), respectively. We measured the proportion of men who elected noncurative initial treatment and used multivariate logistic regression analysis to evaluate factors affecting the treatment choice.
  
  
  RESULTS
  During the study period noncurative initial management increased in patients at low risk from 21% to 32% in SEER and from 13% to 20% in NCDB (each p < 0.001). This increase was not reflected in our overall study population (SEER 20% to 22% and NCDB 11% to 13%) since the proportion of patients with Gleason score 6 or less decreased with time (61% to 49% and 61% to 45%, respectively). From 2004 to 2010 older age, lower prostate specific antigen, earlier clinical stage, increased comorbidity index and not being married were associated with a higher likelihood of noncurative initial management (each p < 0.05).
  
  
  CONCLUSIONS
  Two independently managed, population based data sets confirmed a temporal increase in noncurative initial management in patients with low risk PCa that did not translate into greater use overall in those at low and intermediate risk combined. These contrasting results are likely due to grade migration resulting in fewer men being classified as with low risk PCa based on Gleason score.
authors.affiliation: Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Weiner
authors.affiliation: Section of Urology, University of Chicago, Chicago, Illinois.
authors.forename: Sanjay G
authors.initials: SG
authors.lastname: Patel
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Ruth
authors.initials: R
authors.lastname: Etzioni
authors.affiliation: Department of Surgery, University of Chicago, Chicago, Illinois. Electronic address: seggener@surgery.bsd.uchicago.edu.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Eggener
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000628:therapy*; D018570:Risk Assessment; D014481:United States; D057832:Watchful Waiting / Q000639:trends*
keywords: SEER program; prostate; prostatic neoplasms; risk; trends