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. 2023 Jan;41(1):93-99.
doi: 10.1007/s00345-022-04228-4. Epub 2022 Dec 6.

Prostate cancer mortality rates in low- and favorable intermediate-risk active surveillance patients: a population-based competing risks analysis

Rashid K Sayyid  1 , John Z Benton  2 , William C Reed  3 , Phillip Woodruff  3 , Martha K Terris  3   4 , Christopher J D Wallis #  5 , Zachary Klaassen #  3   4
Affiliations

Prostate cancer mortality rates in low- and favorable intermediate-risk active surveillance patients: a population-based competing risks analysis

Rashid K Sayyid et al. World J Urol. 2023 Jan.

Abstract

Purpose: To determine prostate cancer (PCa) and other-cause mortality rates in low- and favorable intermediate-risk (FIR) active surveillance (AS) patients.

Methods: The SEER Prostate with Watchful Waiting database was used to identify men diagnosed with NCCN low or FIR PCa, between 2010 and 2015, managed with AS. FIR patients were subdivided into three subgroups, based on their intermediate risk factor: grade group two (GG2), PSA 10-20 ng/ml or cT2b-c disease. Cumulative incidence function curves with other-cause mortality as the competing risk were utilized. Predictors of PCa mortality were assessed using multivariable regression analysis with semi-parametric proportional hazards modeling.

Results: Among 70,871 patients, 48,127 (67.9%) had low and 22,744 (32.1%) had FIR disease. Median patient age was 64.0 years, and median PSA was 5.70 ng/ml. Median follow-up was 49.0 months. There were 166 (0.2%) PCa and 3,176 (4.48%) other-cause mortalities. The 5-year mortality rates in the low and FIR cohorts overall were 0.29% and 0.28%, respectively (p = 0.64). Within the FIR cohort, the corresponding rates were highest in the PSA 10-20 ng/ml subgroup at 0.73%, followed by 0.32% for GG2 FIR and 0.052% for cT2b-c FIR disease (p < 0.001). Older age at diagnosis (sHR 2.38, p = 0.006), Medicaid insurance (sHR: 2.58, p < 0.001), low socioeconomic (sHR 1.39, p = 0.032), and non-married statuses (sHR: 2.58, p < 0.001) were associated with increased PCa mortality.

Conclusion: Intermediate-term PCa mortality rates in FIR PCa patients are non-significantly different to those with low-risk PCa. However, there is significant within-group heterogeneity, with PCa mortality rates significantly higher in the PSA 10-20 subgroup.

Keywords: Demography; Epidemiology; Mortality; Prostatic neoplasms.

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References

    1. Sanda MG, Cadeddu JA, Kirkby et al (2018) Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part I: Risk Stratification, Shared Decision Making, and Care Options. J Urol 199(3):683–690.
    1. Klotz L (2017) Active surveillance for low-risk prostate cancer. Curr Opin Urol 27(3):225–230 - DOI
    1. Klotz L, Vesprini D, Sethukavalan P et al (2015) Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 33(3):272–277 - DOI
    1. Wu X, Lv D, Eftekhar M et al (2021) Cause-specific mortality of low and selective intermediate-risk prostate cancer patients with active surveillance or watchful waiting. Transl Androl Urol 10(1):154–163 - DOI
    1. Bokhorst LP, Valdagni R, Rannikko A et al (2016) A Decade of Active Surveillance in the PRIAS Study: An Update and Evaluation of the Criteria Used to Recommend a Switch to Active Treatment. Eur Urol 70(6):954–960 - DOI

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