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Multicenter Study
. 2021 Jul;39(7):432.e1-432.e10.
doi: 10.1016/j.urolonc.2020.11.024. Epub 2020 Dec 9.

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

Yu Liu  1 , Ingrid J Hall  2 , Christopher Filson  3 , David H Howard  4
Affiliations
Multicenter Study

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

Yu Liu et al. Urol Oncol. 2021 Jul.

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.

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Conflict of interest statement

Conflict of interest: None.

Figures

Fig. 1.
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.
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.
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.
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.
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