Trends in the use of active surveillance and treatments in Medicare beneficiaries diagnosed with localized prostate cancer

Abstract

Background: The treatment for men diagnosed with localized prostate cancer has changed over time given the increased attention to the harms associated with over-diagnosis and the development of protocols for active surveillance.

Methods: We examined trends in the treatment of men diagnosed with localized prostate cancer between 2004 and 2015, using the most recently available data from Surveillance, Epidemiology, and End Results Program (SEER)-Medicare. Patients were stratified by Gleason score, age, and race groups.

Results: The use of active surveillance increased from 22% in 2004-2005 to 50% in 2014-2015 for patients with a Gleason score of 6 or below and increased from 9% in 2004-2005 to 13% in 2014-2015 for patients with a Gleason score of 7 or above. Patients with a Gleason score of 7 or above had increased use of intensity-modulated radiation therapy and prostatectomy, especially among patients aged 75 years and older. Among patients with a Gleason score of 6 or below non-Hispanic black men were less likely to undergo active surveillance than non-Hispanic white men.

Conclusions: There has been a large increase in the use of active surveillance among men with a Gleason score of 6 or below. However, non-Hispanic black men with a Gleason score of 6 or below are less likely to receive active surveillance.

Keywords: Active surveillance; New treatment methods; Prostate cancer; Treatment disparities; Treatment trends.

Fig. 1.

Trends in initial treatment of new localized prostate cancer, SEER-Medicare, 2004–2015. Percent of patients undergoing prostatectomy, IMRT, other active treatment, active surveillance, or no treatment by treatment year. IMRT = intensity-modulated radiation therapy, SEER = Surveillance, Epidemiology, and End Results.

Fig. 2.

Trends in initial treatment of new localized prostate cancer by Gleason score, SEER-Medicare, 2004–2015. Percent of patients undergoing prostatectomy, IMRT, other active treatment, active surveillance, or no treatment by treatment year and Gleason score (6 and below, 7 and above). IMRT = intensity-modulated radiation therapy, SEER = Surveillance, Epidemiology, and End Results.

Fig. 3.

Trends in initial treatment of new localized prostate cancer by age group and Gleason score, SEER-Medicare, 2004–2015. Percent of patients undergoing prostatectomy, IMRT, other active treatment, active surveillance, or no treatment by treatment year, age (66–74 years, 75 years and above), and Gleason score (6 and below, 7 and above). IMRT = intensity-modulated radiation therapy, SEER = Surveillance, Epidemiology, and End Results.

Fig. 4.

Trends in initial treatment of new localized prostate cancer by race and Gleason score, SEER-Medicare, 2004–2015. Percent of patients undergoing prostatectomy, IMRT, other active treatment, active surveillance, or no treatment by treatment year, race (non-Hispanic white, non-Hispanic black), and Gleason score (6 and below, 7 and above). IMRT = intensity-modulated radiation therapy, SEER = Surveillance, Epidemiology, and End Results.