Pd13-03 Overtreatment of Men With Limited Life Expectancy for Early Stage Prostate Cancer Has Increased in the Active Surveillance Era

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (PD13)1 May 2024PD13-03 OVERTREATMENT OF MEN WITH LIMITED LIFE EXPECTANCY FOR EARLY STAGE PROSTATE CANCER HAS INCREASED IN THE ACTIVE SURVEILLANCE ERA Timothy J. Daskivich, John Heard, I-Chun Thomoas, and John Leppert Timothy J. DaskivichTimothy J. Daskivich , John HeardJohn Heard , I-Chun ThomoasI-Chun Thomoas , and John LeppertJohn Leppert View All Author Informationhttps://doi.org/10.1097/01.JU.0001009552.62973.71.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men with limited life expectancy (LE) have historically been overtreated for prostate cancer despite clear guidelines recommendations. With the increasing use of active surveillance, it is unclear if overtreatment of men with limited LE has persisted in the recent era and how overtreatment varies by prostate cancer risk and treatment type. METHODS: We performed an observational study of men with clinically localized prostate cancer in the Veterans Affairs Health System diagnosed between 2000 and 2019. LE was estimated using the validated age-adjusted Prostate Cancer Comorbidity Index (PCCI). Treatment trends over time among men with limited LE were assessed using multivariable linear and log-linear Poisson regressions in aggregate and across tumor risk subgroups. RESULTS: Our analytic sample included 243,928 men, of which 50,045 (20.5%) and 2,022 (4.7%) had LE5 and >10, respectively. Of men with LE<10 and LE<5 years, 13,140 (27.6%) and 3,488 (33.3%) men met criteria for overtreatment. Among men with LE<10 years, the proportion of men treated with definitive treatment (surgery or radiation therapy) decreased for low-risk disease from 37% to 17% (difference -20%) and increased for intermediate-risk disease from 38% to 62% (difference +24%) from 2000 to 2019 (Figure 1). The predominant treatment type among these men was radiation therapy (78%), which increased among men with intermediate-risk disease (31% to 46%, difference+15%) and decreased among men with low-risk disease (32% to 19%, difference -13%) (Figure 2). Among men with LE<5 years, the proportion of men treated with definitive treatment for high-risk disease increased from 17% to 47% (difference +31%) from 2000 to 2019 (Figure 1). 86% of men that were overtreated received radiation therapy (Figure 2). CONCLUSIONS: In the active surveillance era, overtreatment of men with limited LE has increased for intermediate- and high-risk prostate cancers, mainly with radiation therapy. Download PPTDownload PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e263 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Timothy J. Daskivich More articles by this author John Heard More articles by this author I-Chun Thomoas More articles by this author John Leppert More articles by this author Expand All Advertisement PDF downloadLoading ...