Sociodemographic and Clinical Predictors of Switching to Active Treatment among a Large, Ethnically Diverse Cohort of Men with Low Risk Prostate Cancer on Observational Management.
OBJECTIVE
We determined the clinical and sociodemographic predictors of beginning active treatment in an ethnically diverse population of men with low risk prostate cancer initially on observational treatment.


METHODS
We retrospectively studied men diagnosed with low risk prostate cancer between 2004 and 2012 at Kaiser Permanente Northern California who did not receive any treatment within the first year of diagnosis and had at least 2 years of followup. We used Cox proportional hazards regression models to determine factors associated with time from diagnosis to active treatment.


RESULTS
We identified 2,228 eligible men who were initially on observation, of whom 27% began active treatment during followup at a median of 2.9 years. NonHispanic black men were marginally more likely to begin active treatment than nonHispanic white men independent of baseline and followup clinical measures (HR 1.3, 95% CI 1.0-1.7). Among men who remained on observation nonHispanic black men were rebiopsied within 24 months of diagnosis at a slightly lower rate than nonHispanic white men (HR 0.70, 95% CI 0.6-1.0). Gleason grade progression (HR 3.3, 95% CI 2.7-4.1) and PSA doubling time less than 48 months (HR 2.9, 95% CI 2.3-3.7) were associated with initiation of active treatment independent of race.


CONCLUSIONS
Sociodemographic factors such as ethnicity and education may independently influence the patient decision to pursue active treatment and serial biopsies during active surveillance. These factors are important for further studies of prostate cancer treatment decision making.
Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C.. Electronic address: spk23@georgetown.edu.
Scott P
SP
Kelly
Department of Urology, Kaiser Oakland Medical Center, Northern California, Oakland, California.
Stephen K
SK
Van Den Eeden
Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Richard M
RM
Hoffman
Department of Urology, Kaiser Oakland Medical Center, Northern California, Oakland, California.
David S
DS
Aaronson
Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C.
Tania
T
Lobo
Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C.
George
G
Luta
Division of Research, Kaiser Permanente Northern California, Oakland, California.
Amethyst D
AD
Leimpter
Division of Research, Kaiser Permanente Northern California, Oakland, California.
Jun
J
Shan
Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C.
Arnold L
AL
Potosky
Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C.
Kathryn L
KL
Taylor
D000328:Adult; D000368:Aged; D001706:Biopsy; D002140:California / Q000453:epidemiology; D003131:Combined Modality Therapy; D018450:Disease Progression; D005006:Ethnicity; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011467:Prostate / Q000000981:diagnostic imaging*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors
African Americans; disease progression; early detection of cancer; prostatic neoplasms; watchful waiting