title: The Association Between Evaluation at Academic Centers and the Likelihood of Expectant Management in Low-risk Prostate Cancer.
abstract: To identify factors associated with expectant management (EM) in a large cohort of men with low-risk prostate cancer based on cancer center type (community vs academic). EM, consisting of active surveillance or observation for men with low-risk prostate cancer, is an increasingly recognized management option, given the morbidity and lack of a survival benefit associated with definitive treatment. However, the influence of cancer center type on treatment selection is uncertain.
  
  
  
  We performed a retrospective analysis of the National Cancer Data Base from 2010 to 2013. Men with low-risk prostate cancer were divided by management strategy into groups consisting of EM or definitive treatment. The association between management strategy and facility type (community vs academic) was characterized using 2-level hierarchical mixed effects logistic regression models.
  
  
  
  There were 52,417 (57%) men evaluated at community centers and 39,139 men (43%) evaluated at academic centers. Patients evaluated at academic centers were significantly more likely to receive EM than those at community centers (17% vs 8%, P < .001). After adjusting for pertinent covariates, evaluation at an academic vs community facility was independently associated with increased odds of EM utilization (adjusted odds ratio 2.70, 95% confidence interval 2.00-3.66). Fifty-one percent of the total variance was explained by interfacility variation.
  
  
  
  The likelihood of receiving EM for low-risk prostate cancer was significantly lower in men evaluated at community centers. Further investigation is warranted to elucidate factors that influence the management of low-risk prostate cancer, including individual treatment center patterns.
authors.affiliation: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT. Electronic address: nataniel.lester-coll@yale.edu.
authors.forename: Nataniel H
authors.initials: NH
authors.lastname: Lester-Coll
authors.affiliation: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT.
authors.forename: Henry S
authors.initials: HS
authors.lastname: Park
authors.affiliation: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Rutter
authors.affiliation: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Corso
authors.affiliation: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT.
authors.forename: Brandon R
authors.initials: BR
authors.lastname: Mancini
authors.affiliation: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT.
authors.forename: Debra N
authors.initials: DN
authors.lastname: Yeboa
authors.affiliation: Urology Institute, Case Western Reserve University School of Medicine, University Hospital Case Medical Center, Cleveland, OH.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, CT; Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, CT; Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT.
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000066491:Clinical Decision-Making; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D057832:Watchful Waiting